2015-10-29T16:04:22-05:00 2014-12-31 721088864 LAPORTE APAC 111 VETERANS MEMORIAL BLVD SUITE 600 METAIRIE LA 700054958 990 2014-01-01 720945796 COMMUNITY COFFEE COMPANY LLC EMPLOYEE HEALTH & LIFE BENEFITS PLAN COMM 2253683900 PO BOX 791 BATON ROUGE LA 708210791 ANNETTE VACCARO OFFICER 2253683900 2015-10-27 1 SEAN O'NEILL CPA P01061021 5048355522 2014 2016-02-25 16:41:14Z ANNETTE VACCARO PO BOX 791 BATON ROUGE LA 708210791 7360952 0 X N/A X 1997 LA PROVIDE TAX SHELTERED HEALTH AND LIFE BENEFITS TO EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC. 1 0 0 0 0 0 0 0 6228721 7360952 0 0 0 0 6228721 7360952 0 0 5631824 6684240 0 0 0 0 0 596897 676712 6228721 7360952 0 0 715000 715000 2056969 2605860 -1341969 -1890860 TO PROVIDE THE EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC TAX SHELTERED HEALTH AND LIFE BENEFITS. 0 0 7360952 7360952 PROVIDE HEALTH AND LIFE BENEFITS TO EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC. 7360952 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 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X ANNETTE VACCARO 2252913900 3332 PARTRIDGE LANE BLDG A BATON ROUGE LA 70809 X COMMUNITY COFFEE COMPANY LLC TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 UNITED HEALTHCARE 3838 NORTH CAUSEWAY BLVD 2100 METAIRIE LA 70002 PLAN ADMINISTRATION 447009 WELLNET 3060 ROUTE 97 SUITE 290 GLENWOOD MO 21738 WELLNESS ADMINISTRATOR 137076 2 EMPLOYER CONTRIBUTIONS 900099 4514941 4514941 PARTICIPANT CONTRIBUTI 900099 2846011 2846011 7360952 7360952 7360952 0 0 6684240 676712 7360952 715000 715000 715000 715000 650000 715000 1406969 1890860 2056969 2605860 X 0 0 0 0 -1341969 -1890860 -1341969 -1890860 715000 715000 X 0 -548891 X 0 1 X 1 0 0 POST-RETIREMENT BENEFIT OBLIGATIONS 1890860 1890860 X 7360952 0 7360952 0 7360952 7360952 0 7360952 0 7360952 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA PROVIDE ACCOUNTING AND DISCLOSURE GUIDANCE ABOUT POSITIONS TAKEN BY A PLAN IN ITS TAX RETURNS THAT MIGHT BE UNCERTAIN. THE PLAN ADMINISTRATOR BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 IS PROVIDED TO THE DIRECTOR OF ACCOUNTING AND TREASURY. IT IS REVIEWED FOR ACCURACY AND PROPRIETY. THE RETURN IS THEN REVIEWED BY THE CFO, WHO PROVIDES THE FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12 COMMUNITY COFFEE COMPANY, LLC EMPLOYEE HEALTH & LIFE BENEFITS PLAN DOES NOT HAVE THE POLICIES AND PROCEDURES AS NOTED ON PAGE 6, PART VI BECAUSE: 1. IT HAS NO EMPLOYEES OR BOARD OF DIRECTORS SO THERE IS NO ONE THE POLICIES WOULD APPLY TO. 2. IT IS A TRUST WHICH MERELY HOLDS FUNDS FOR EMPLOYEE AND RETIREE INSURANCE PAYMENTS. 3. COMMUNITY COFFEE COMPANY, LLC SERVES AS ITS TRUSTEE, WHICH HAS AN OUTSIDE FINANCIAL INSTITUTION TO MONITOR ITS INVESTMENTS AND AN OUTSIDE BOARD TO MONITOR COMPANY ACTIVITIES, POLICIES, AND PROCEDURES. 4. IT IS THE HEALTH AND LIFE BENEFITS PLAN OF COMMUNITY COFFEE COMPANY, LLC, WHICH HAS A CONFLICT OF INTEREST POLICY, A DOCUMENT RETENTION POLICY, A WHISTLEBLOWER POLICY, AND A COMPENSATION POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND TAX RETURNS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. HOWEVER, THE ORGANIZATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY. FORM 990, PART XI, LINE 9: CHANGE IN ACTUARIAL COMPUTATION -548,891. COMMUNITY COFFEE LLC PO BOX 791 BATON ROUGE LA 70821 720478429 SALES/DISTRIBUTION LA C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMUNITY COFFEE LLC L 4514941 FAIR MARKET VALUE