MAXUS RETIREES MODIFIED MEDICAL BENEFITS TR: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: MAXUS RETIREES MODIFIED MEDICAL BENEFITS TR (EIN 36-7705138)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-06-30
IRS object ID: 202211819349300741
Schema version: 2021v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-06-30T13:37:36-05:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	751835758	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	LAIN FAULKNER & CO PC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	400 N ST PAUL STE 600	AddressLine1Txt
City	DALLAS	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	75201	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	367705138	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MAXUS RETIREES MODIFIED MEDICAL BENEFITS	BusinessNameLine1Txt
Business Name Line2	DENNIS FAULKNER TRUSTEE	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	MAXU	BusinessNameControlTxt
Phone	2147201929	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	400 N ST PAUL STREET 600	AddressLine1Txt
City	DALLAS	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	75201	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DENNIS FAULKNER	PersonNm
Person Title	TRUSTEE	PersonTitleTxt
Phone	2147201929	PhoneNum
Signature	2022-06-30	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	DENNIS	PersonFirstNm
Person Last	FAULKNER	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DEAN S BIELITZ	PreparerPersonNm
PTIN	P00708325	PTIN
Phone	2147201929	PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	DENNIS FAULKNER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	400 N ST PAUL ST 600	AddressLine1Txt
City	DALLAS	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	75201	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$40,432	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c	Yes (X)	Organization501cInd
Website Address	N/A	WebsiteAddressTxt
Type Of Organization Trust	Yes (X)	TypeOfOrganizationTrustInd
Formation	2017	FormationYr
Legal Domicile State	TX	LegalDomicileStateCd
Activity Or Mission	THIS HEALTH PLAN IS ORGANIZED UNDER SEC. 501(C)(9) AND OFFERS A BROAD HEALTH CARE PROGRAM INCLUDING MEDICAL BENEFITS.	ActivityOrMissionDesc
Voting Members Governing Body	2	VotingMembersGoverningBodyCnt
Voting Members Independent	2	VotingMembersIndependentCnt
Total Employee	0	TotalEmployeeCnt
Total Volunteers	0	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$0	PYContributionsGrantsAmt
CY Contributions Grants	$0	CYContributionsGrantsAmt
PY Program Service Revenue	$46,610	PYProgramServiceRevenueAmt
CY Program Service Revenue	$40,104	CYProgramServiceRevenueAmt
PY Investment Income	$14,478	PYInvestmentIncomeAmt
CY Investment Income	$328	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$61,088	PYTotalRevenueAmt
CY Total Revenue	$40,432	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$108,791	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$99,463	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,000	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$4,000	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$87,339	PYOtherExpensesAmt
CY Other Expenses	$84,563	CYOtherExpensesAmt
PY Total Expenses	$197,130	PYTotalExpensesAmt
CY Total Expenses	$188,026	CYTotalExpensesAmt
PY Revenues Less Expenses	-$136,042	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$147,594	CYRevenuesLessExpensesAmt
Total Assets BOY	$943,759	TotalAssetsBOYAmt
Total Assets EOY	$796,165	TotalAssetsEOYAmt
Total Liabilities BOY	$0	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$943,759	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$796,165	NetAssetsOrFundBalancesEOYAmt
Mission	THIS HEALTH PLAN IS ORGANIZED UNDER SEC. 501(C)(9) AND OFFERS A BROAD HEALTH CARE PROGRAM INCLUDING MEDICAL BENEFITS.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$99,463	ExpenseAmt
Desc	THIS HEALTH PLAN IS ORGANIZED UNDER SEC. 501 (C) (9) AND OFFERS A BROAD HEALTH CARE PROGRAM INCLUDING MEDICAL BENEFITS. THERE ARE CURRENTLY 73 PARTICPANTS IN THE PLAN.	Desc
Total Program Service Expenses	$99,463	TotalProgramServiceExpensesAmt
Described In Section501c3	0	DescribedInSection501c3Ind
Schedule B Required	0	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	0	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	0	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	0	EmployeeCnt
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	2	GoverningBodyVotingMembersCnt
Independent Voting Member	2	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	0	ConflictOfInterestPolicyInd
Whistleblower Policy	0	WhistleblowerPolicyInd
Document Retention Policy	0	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	0	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LAIN FAULKNER & CO PC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	2147201929	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	400 N ST PAUL STREET 600	AddressLine1Txt
City	DALLAS	CityNm
State Abbreviation	TX	StateAbbreviationCd
ZIP	75201	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (2 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
DENNIS FAULKNER
TRUSTEE	0.00	Yes (X)	$0	$0	$0
RICHARD SCHMIDT
COMMITTEE MEMBER	1.00	Yes (X)	$4,000	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$4,000	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$0	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	0	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	EMPLOYER CONTRIBUTIONS	Desc
Business	525100	BusinessCd
Total Revenue Column	$40,104	TotalRevenueColumnAmt
Exclusion	$40,104	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$40,104	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$328	TotalRevenueColumnAmt
Related Or Exempt Func Income	$328	RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$40,432	TotalRevenueColumnAmt
Related Or Exempt Func Income	$328	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$40,104	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$99,463	TotalAmt
Program Services	$99,463	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$4,000	TotalAmt
Management And General	$4,000	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$45,757	TotalAmt
Management And General	$45,757	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$38,806	TotalAmt
Management And General	$38,806	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$188,026	TotalAmt
Program Services	$99,463	ProgramServicesAmt
Management And General	$88,563	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$41,593	BOYAmt
EOY	$18,671	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$902,166	BOYAmt
EOY	$777,494	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$943,759	BOYAmt
EOY	$796,165	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Field	Value	IRS element (for citing)
Org Does Not Follow FASB117	Yes (X)	OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

Field	Value	IRS element (for citing)
BOY	$943,759	BOYAmt
EOY	$796,165	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$943,759	BOYAmt
EOY	$796,165	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$943,759	BOYAmt
EOY	$796,165	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	-$147,594	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Method Of Accounting Cash	Yes (X)	MethodOfAccountingCashInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$0	TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt	$40,432	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$40,432	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$40,432	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$188,026	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$188,026	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$188,026	TotalExpensesPerForm990Amt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11B	LINE 11A EXPLANATION - TAX DEPARTMENT REVIEWS ALL ACCOUNTING ENTRIES POSTED TO TAX FORM 990.
FORM 990, PART VI, SECTION C, LINE 19	NO DOCUMENTS AVAILABLE TO THE PUBLIC
FORM 990, PART IX, LINE 11G	OTHER ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,574. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,574. INSURANCE BOND: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 201. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 201. OFFICE EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 231. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 231. AUDIT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 14,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,800.