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HEALTHALLIANCE BENEFIT PLAN: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
HEALTHALLIANCE BENEFIT PLAN (EIN 42-6167033)
Tax period
2018-07-01 to 2019-06-30
Filed
2019-10-11
IRS object ID
201912849349300116
Schema version
2018v3.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2019-10-11T09:41:23-05:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN421104473PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MCGOWEN HURST CLARK & SMITH PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11601 W LAKES PKWY STE 300AddressLine1Txt
CityWEST DES MOINESCityNm
State AbbreviationIAStateAbbreviationCd
ZIP50266ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN426167033EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PMCI TRUSTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPMCIBusinessNameControlTxt
Phone5152247545PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110430 NEW YORK AVE SUITE FAddressLine1Txt
CityURBANDALECityNm
State AbbreviationIAStateAbbreviationCd
ZIP50322ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAWN CARLSONPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5152247545PhoneNum
Signature2019-10-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonS JAMES SMITH CPAPreparerPersonNm
PTINP00040250PTIN
Phone5152883279PhoneNum
Preparation2019-10-10PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address167.142.51.230IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-10-11IPDt
IP Tm09:41:23IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id10637D6A6B1BECE7EDBDD541E4C064C83ABC94BCAtSubmissionCreationDeviceId
At Submission Filing Device IdCF8051CA1996F51273878CF5C0CF0181AC9EEA30AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-01-14 16:20:31ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1HEALTHALLIANCE BENEFIT PLANBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDAWN CARLSONPrincipalOfficerNm
Gross Receipts$15,340,331GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1950FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionPROVIDES HEALTH, DENTAL, VISION AND LIFE INSURANCE PRODUCTS AND SERVICES TO FUELIOWA MEMBERS.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers4TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$12,102,281PYProgramServiceRevenueAmt
CY Program Service Revenue$14,508,885CYProgramServiceRevenueAmt
PY Investment Income$58,382PYInvestmentIncomeAmt
CY Investment Income$92,047CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$12,160,663PYTotalRevenueAmt
CY Total Revenue$14,600,932CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$8,924,775PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$12,163,982CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,485,290PYOtherExpensesAmt
CY Other Expenses$2,999,391CYOtherExpensesAmt
PY Total Expenses$11,410,065PYTotalExpensesAmt
CY Total Expenses$15,163,373CYTotalExpensesAmt
PY Revenues Less Expenses$750,598PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$562,441CYRevenuesLessExpensesAmt
Total Assets BOY$3,229,283TotalAssetsBOYAmt
Total Assets EOY$2,746,295TotalAssetsEOYAmt
Total Liabilities BOY$96,833TotalLiabilitiesBOYAmt
Total Liabilities EOY$72,786TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,132,450NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,673,509NetAssetsOrFundBalancesEOYAmt
MissionHEALTHALLIANCE BENEFIT PLAN PROVIDES HEALTH, DENTAL, VISION AND LIFE INSURANCE PRODUCTS AND SERVICES TO MEMBERS OF FUELIOWA AND OTHER QUALIFIED LIKE-INDUSTRY PARTICIPANTS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$15,163,373ExpenseAmt
Revenue$14,508,885RevenueAmt
DescHEALTHALLIANCE BENEFIT PLAN PROVIDES VARIOUS TYPES OF GROUP INSURANCE COVERAGE FOR MEMBERS OF THE FUELIOWA TRADE ASSOCIATION.Desc
Total Program Service Expenses$15,163,373TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAWN CARLSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5152247545PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110430 NEW YORK AVE SUITE FAddressLine1Txt
CityURBANDALECityNm
State AbbreviationIAStateAbbreviationCd
ZIP50322ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
BRYAN BANDSTRA
TRUSTEE CHAI0.50Yes (X)Yes (X)$0$0$0
BROOKE LILLEY
TRUSTEE0.50Yes (X)$0$0$0
LISA ABENS
TRUSTEE0.50Yes (X)$0$0$0
ANDREW WOODARD
TRUSTEE0.50Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Business Name Line2ContractorName/BusinessName/BusinessNameLine2TxtAddress Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
WELLMARK BLUE CROSS BLUE SHIELD
OF IOWAPO BOX 9124DES MOINESIA503069124HEALTH INS.$628,423
LA MAIR-MULOCK-CONDON CO
4200 UNIVERSITY AVE SUITE 200WEST DES MOINESIA502665945INS. CONSULTING$205,346
MILLIMAN
1120 SOUTH 101ST STREET SUITE 400OMAHANE68124ACTUARY SERVICE$107,807
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
INSURANCE PREMIUMS524298$12,195,056$12,195,056
EXCESS STOP LOSS900099$2,012,339$2,012,339
PHARMACY REBATES900099$301,028$301,028
MISCELLANEOUS900099$462$462
FieldValueIRS element (for citing)
Total Program Service Revenue$14,508,885TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$71,529TotalRevenueColumnAmt
Exclusion$71,529ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$759,917SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$739,399SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$20,518SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,518TotalRevenueColumnAmt
Exclusion$20,518ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,600,932TotalRevenueColumnAmt
Related Or Exempt Func Income$14,508,885RelatedOrExemptFuncIncomeAmt
Exclusion$92,047ExclusionAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$12,163,982TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$36,957TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$70,671TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$17,015TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$313,153TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$5,000TotalAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmt
STOP LOSS INS. PREMIUMS$1,783,913
ADMINISTRATIVE CHARGES$762,500
MISCELLANEOUS$10,182

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,163,373TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$637,967BOYAmt
EOY$326,447EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,591,316BOYAmt
EOY$2,419,848EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,229,283BOYAmt
EOY$2,746,295EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$49,385BOYAmt
EOY$45,303EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$46,419BOYAmt
EOY$26,378EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,029BOYAmt
EOY$1,105EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$96,833BOYAmt
EOY$72,786EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$3,132,450BOYAmt
EOY$2,673,509EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,132,450BOYAmt
EOY$2,673,509EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,229,283BOYAmt
EOY$2,746,295EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$562,441ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$103,500NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATEDesc
Amt$1,105Amt
FieldValueIRS element (for citing)
Total Liability$1,105TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$14,687,417TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$103,500NetUnrealizedGainsInvstAmt
Revenue Not Reported$103,500RevenueNotReportedAmt
Revenue Subtotal$14,583,917RevenueSubtotalAmt
Investment Expenses Not Incld$17,015InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$17,015RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$14,600,932TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$15,146,358TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$15,146,358ExpensesSubtotalAmt
Investment Expenses Not Incld2$17,015InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$17,015ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$15,163,373TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationTHE VEBA TRUST FUNDING THE BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED FEBRUARY 23, 1988, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501 (C)(9) OF THE INTERNAL REVENUE CODE (IRC). UNRELATED BUSINESS INCOME TAX, IF ANY, WOULD BE RECORDED AS AN ADMINISTRATIVE EXPENSE OF THE PLAN. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN FISCAL YEARS ENDING JUNE 30, 2019 AND 2018 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE INCOME TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 11BTHE BOARD OF TRUSTEES OF HEALTHALLIANCE BENEFIT PLAN ARE PROVIDED WITH A COMPLETE COPY OF THE FORM 990 BEFORE IT IS FILED. THE FORM IS PROVIDED TO TRUSTEES AND PRESENTED AT A MEETING OF THE TRUSTEES FOR COMMENTS AND QUESTIONS.
FORM 990, PAGE 6, PART VI, LINE 12CTHE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE TRUSTEES AND ANY CONFLICTS ARE RECORDED IN THE MINUTES.
FORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
PMCI DBA FUELIOWA
10430 NEW YORK AVE SUITE FURBANDALEIA50322420332565TRADE ASSOIA501C6N/Afalse
IOWA BENEFIT ADMINISTRATORS
10430 NEW YORK AVE SUITE FURBANDALEIA50322273776704PLAN ADMINIA501C6falseFUELIOWA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1RIN ALLIANCE INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110430 NEW YORK AVE SUITE FAddressLine1Txt
CityURBANDALECityNm
State AbbreviationIAStateAbbreviationCd
ZIP50322ZIPCd
FieldValueIRS element (for citing)
EIN420947359EIN
Primary ActivitiesCOMPLIANCEPrimaryActivitiesTxt
Legal Domicile StateIALegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE RFormAndLineReferenceDesc
ExplanationPART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: IOWA BENEFIT ADMINISTRATORS PRIMARY ACTIVITY: PLAN ADMINISTRATION DIRECT CONTROLLING ENTITY: PMCI, DBA FUELIOWA PART IV, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST: NAME OF RELATED ORGANIZATION: RIN ALLIANCE, INC. PRIMARY ACTIVITY: ASSISTS SUBSCRIBERS IN COMPLIANCE & MARKETING RINS DIRECT CONTROLLING ENTITY: PMCI, DBA FUELIOWAExplanationTxt