2025-08-28T08:54:43-05:00 2024-10-31 420714325 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2023-11-01 367742028 PLAN A HEALTH CARE PLAN TRUST PLAN 3093431550 285 S FARNHAM ST GALESBURG IL 61401 BRIAN BURGER TRUSTEE 3093431550 2025-08-25 1 1 KAREN O CRIM P00368385 9372980201 2025-08-25 2023 2025-03-06 01:10:19Z BRIAN BURGER 285 S FARNHAM ST GALESBURG IL 61401 10175137 0 X N/A X 2019 IL TO PROVIDE MEDICAL, SHORT-TERM DISABILITY & DEATH BENEFITS FOR ELIGIBLE EMPLOYEES & DEPENDENTS. 2 2 0 2 0 0 0 0 7674736 10107028 45743 68109 0 0 7720479 10175137 0 0 8443311 9037254 0 0 0 0 0 1508270 1695716 9951581 10732970 -2231102 -557833 2738825 1738417 1905063 1453073 833762 285344 X THE PLAN IS A SELF-INSURED BENEFIT PROGRAM FUNDED BY THE EMPLOYERS AND PARTICIPANTS WITHIN THE PLAN. PARTICIPANTS IN THE PLAN ARE CURRENT AND FORMER EMPLOYEES OF THE FOLLOWING SPONSORS: COMMUNITY LIVING OPTIONS, INC., FRANCES HOUSE, INC., UNLIMITED DEVELOPMENT, INC., ACHIEVEMENT UNLIMITED, INC., PINNACLE OPPORTUNITIES, INC., PIONEER CONCEPTS, INC., RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., DESERT HEALTH CARE FACILITIES, INC., AND LTC SUPPORT SERVICES, LLC. PLAN ASSETS ARE HELD IN A VOLUNTARY EMPLOYEES' BENEFIT ASSOCIATION (VEBA) TRUST. THE PLAN IS SUBJECT TO THE PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA), AS AMENDED. DESERT HEALTH CARE FACILITIES, INC. SOLD ITS OPERATIONS IN APRIL 2024 AND NO LONGER PARTICIPATES IN THE PLAN, AS ALL EMPLOYEES WERE TRANSFERRED TO THE NEW OWNER. 0 0 THE PURPOSE OF THE PLAN IS TO PROVIDE MEDICAL, SHORT-TERM DISABILITY, AND DEATH BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS THAT VOLUNTARILY ELECT TO PARTICIPATE IN THE PLAN. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 X BRIAN BURGER 3093431550 285 S FARNHAM ST GALESBURG IL 61401 X X RONALD WILSON TRUSTEE 1.00 X 0 0 0 BRIAN BURGER TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 MUTUAL MEDICAL PLANS INC 416 MAIN STREET SUITE 1025 PEORIA IL 61602 ADMINISTRATIVE SERVICES 411840 RSM US LLP 401 MAIN STREET SUITE 1200 PEORIA IL 61602 ACCOUNTING SERVICES 132615 2 X PLAN CONTRIBUTIONS 900001 10107028 10107028 10107028 68109 68109 10175137 10107028 0 68109 9037254 -2225 121387 1152937 ADMINISTRATIVE EXPENSES 423617 10732970 696815 268533 1503627 1259620 237381 210264 301002 0 2738825 1738417 3750 3578 1901313 1449495 1905063 1453073 X 0 0 0 0 833762 285344 833762 285344 2738825 1738417 -557833 9415 0 X X 0 1 X 1 0 0 BENEFITS PAYABLE 1449495 1449495 X 10184552 9415 9415 10175137 0 10175137 11184788 0 11184788 -451818 -451818 10732970 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION. MANAGEMENT HAS EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAS MAINTAINED ITS TAX EXEMPT STATUS AND HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASES IN ESTIMATED OBLIGATIONS FOR CLAIMS INCURRED BUT NOT REPORTED -451,818. COMMUNITY LIVING OPTIONS INC (CLO) CLO, INC. IS THE SPONSOR OF PLAN A HEALTH CARE PLAN TRUST. 1022933 PREMIUMS WERE PAID BY COMMUNITY LIVING OPTIONS, INC. IN THE AMOUNT OF $1,022,933 TO THE PLAN A HEALTH CARE PLAN TRUST FOR THE FISCAL YEAR ENDING OCTOBER 31, 2024. THE PREMIUM AMOUNT FOR COMMUNITY LIVING OPTIONS, INC. PARTICIPANTS IS THE SAME AS THAT CHARGED TO ALL OTHER PARTICIPANTS IN THE PLAN. COMMUNITY LIVING OPTIONS, INC. RECEIVES NO MONEY FROM THE PLAN A HEALTH CARE PLAN TRUST. BRIAN BURGER, CO-TRUSTEE OF THE PLAN A HEALTH CARE PLAN TRUST IS THE CHIEF FINANCIAL OFFICER OF COMMUNITY LIVING OPTIONS, INC. THE PLAN A HEALTH CARE PLAN TRUST TRUST PAYS NO COMPENSATION TO THE TRUSTEE OR TO COMMUNITY LIVING OPTIONS, INC. 0 FORM 990, PART V, LINE 1A: THE THIRD PARTY ADMINISTRATOR FOR THE PLAN A HEALTH CARE PLAN TRUST FILES JOINT FORMS 1099 FOR ALL PLANS UNDER THEIR ADMINISTRATION. FORM 990, PART VI, SECTION A, LINE 8A THE NATURE OF THE ENTITY DOES NOT REQUIRE REGULARLY SCHEDULED AND STRUCTURED MEETINGS WITH THE TRUSTEES. THE PURPOSE OF THE ENTITY IS TO ACT AS A CONDUIT FOR MEDICAL BENEFIT PREMIUMS TO BE USED FOR PAYMENT OF MEDICAL CLAIMS OF THE PARTICIPANTS. THE TRUSTEES OVERSEE THE RECEIPT OF PREMIUMS AND THE PAYMENT OF BENEFITS AS REQUIRED, AND ALSO MAKE CERTAIN THAT THE THIRD PARTY ADMINISTRATOR FULFILLS ITS RESPONSIBILITIES. FORM 990, PART VI, SECTION A, LINE 8B THE NATURE OF THE ENTITY DOES NOT REQUIRE REGULARLY SCHEDULED AND STRUCTURED MEETINGS WITH THE TRUSTEES. THE PURPOSE OF THE ENTITY IS TO ACT AS A CONDUIT FOR MEDICAL BENEFIT PREMIUMS TO BE USED FOR PAYMENT OF MEDICAL CLAIMS OF THE PARTICIPANTS. THE TRUSTEES OVERSEE THE RECEIPT OF PREMIUMS AND THE PAYMENT OF BENEFITS AS REQUIRED, AND ALSO MAKE CERTAIN THAT THE THIRD PARTY ADMINISTRATOR FULFILLS ITS RESPONSIBILITIES. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES RECEIVE A PAPER COPY OF FORM 990 FOR THEIR REVIEW AND COMMENT PRIOR TO ITS FILING. FORM 990, PART VI, SECTION C, LINE 18 A COPY OF THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN IRC SECTION 6104(D). FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXCEPT TO COMPLY WITH THE PUBLIC DISCLOSURE REQUIREMENTS. FORM 990, PART VI, SECTION B, LINE 12A: A CONFLICT OF INTEREST POLICY IS NOT REQUIRED FOR THIS ENTITY. THE TRUSTEES RECEIVE NO PAYMENTS OR COMPENSATION FROM THE PLAN A HEALTH CARE PLAN TRUST. THE TRUSTEES ARE EMPLOYED BY RFMS, INC., AN UNRELATED ORGANIZATION, AND RFMS, INC., PROVIDES ADMINISTRATIVE SERVICES TO THE PLAN FREE OF CHARGE. FORM 990, PART VII, SECTION A, LINE 1A, COLUMN B: THE TRUSTEES DEVOTE A PORTION OF THE AVERAGE HOURS PER WEEK TO THE RELATED ORGANIZATIONS LISTED ON SCHEDULE R. HOWEVER, THE ACTUAL HOURS ATTRIBUTABLE TO THESE RELATED ORGANIZATIONS ARE NOT SPECIFICALLY TRACKED. THE HOURS REPORTED IN COLUMN B ARE A REASONABLE ESTIMATE, AND THE TRUSTEES NORMALLY DEVOTE LESS THAN ONE HOUR PER WEEK TO THE PLAN A HEALTH CARE PLAN TRUST. FORM 990, PART VIII, LINE 3 AND PART V, LINE 3A: THE ORGANIZATION IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX ON INVESTMENT INCOME UNDER SECTION 512(A)(3)(E)(III). SUBSTANTIALLY ALL OF THE CONTRIBUTIONS TO THE PLAN A HEALTH CARE PLAN TRUST ARE MADE BY EMPLOYERS WHO WERE EXEMPT FROM TAX THROUGHOUT THE 5-TAXABLE-YEAR PERIOD ENDING WITH THE TAXABLE YEAR IN WHICH THE CONTRIBUTIONS ARE MADE. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT IS THAT THE TWO TRUSTEES MAKE ARRANGEMENTS FOR THE AUDIT, HOWEVER THE ORGANIZATION DOES NOT HAVE A SEPARATE AUDIT COMMITTEE. COMMUNITY LIVING OPTIONS INC 285 S FARNHAM ST GALESBURG IL 61401 371079626 OPERATION OF LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED IL 501(C)(3) LINE 10 N/A 0 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 S FARNHAM ST GALESBURG IL 61401 371223846 OPERATES ELDERLY SKILLED NURSING, ASSISTED/INDEPENDENT LIVING FACILITIES IL 501(C)(3) LINE 10 FRANCES HOUSE INC 0 UNLIMITED DEVELOPMENT INC 285 S FARNHAM ST GALESBURG IL 61401 364094409 OPERATES ELDERLY SKILLED NURSING, ASSISTED/INDEPENDENT LIVING FACILITIES IL 501(C)(3) LINE 10 N/A 0 FRANCES HOUSE INC 285 S FARNHAM ST GALESBURG IL 61401 371087901 OPERATION OF LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED IL 501(C)(3) LINE 10 N/A 0 ACHIEVEMENT UNLIMITED INC 285 S FARNHAM ST GALESBURG IL 61401 364143598 OPERATION OF LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED IL 501(C)(3) LINE 10 N/A 0 PINNACLE OPPORTUNITIES INC 285 S FARNHAM ST GALESBURG IL 61401 364143605 OPERATION OF LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED IL 501(C)(3) LINE 10 FRANCES HOUSE INC 0 PIONEER CONCEPTS INC 285 S FARNHAM ST GALESBURG IL 61401 364143602 OPERATION OF LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED IL 501(C)(3) LINE 10 FRANCES HOUSE INC 0 DESERT HEALTH CARE FACILITIES INC 285 S FARNHAM ST GALESBURG IL 61401 371138846 OPERATES ELDERLY SKILLED NURSING, ASSISTED/INDEPENDENT LIVING FACILITIES NV 501(C)(3) LINE 10 N/A 0 LTC SUPPORT SERVICES LLC 285 S FARNHAM ST GALESBURG IL 61401 208401158 SUPPORTING SERVICES INCLUDING OVERSIGHT, TRAINING, AND REGULATORY COMPLIANCE IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1