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INDIANA LABORERS WELFARE FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
INDIANA LABORERS WELFARE FUND (EIN 35-0923209)
Tax period
2010-12-01 to 2011-11-30
Filed
2012-03-22
IRS object ID
201220829349300537
Schema version
2010v3.7
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)
Timestamp2012-03-22T18:09:40-05:00Timestamp
Tax Period End Date2011-11-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1L M HENDERSON & COMPANY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1450 E 96TH ST STE 200AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46240ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-12-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN350923209EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1INDIANA LABORERS WELFARE FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlINDINameControl
Phone8122382551Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1587AddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code47808ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameFRANK DEGRAWName
TitleSEC-TREASURERTitle
Phone8122382551Phone
Date Signed2012-03-17DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHELLE L ZIMMERMANName
Phone3175661000Phone
Date Prepared2012-03-22DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonFRANK DEGRAWNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1587AddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code47808ZIPCode
FieldValueIRS element (for citing)
Gross Receipts286051649GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteNOT APPLICABLEWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1953YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionPROVIDE HEALTH & WELFARE BENEFITS TO MEMBERSActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees205TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year79197721ProgramServiceRevenuePriorYear
Program Service Revenue CY80880920ProgramServiceRevenueCY
Investment Income Prior Year6327613InvestmentIncomePriorYear
Investment Income Current Year8393388InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year85525334TotalRevenuePriorYear
Total Revenue Current Year89274308TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year59688145BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY66040097BenefitsPaidToMembersCY
Salaries Etc Prior Year2308739SalariesEtcPriorYear
Salaries Etc Current Year2219951SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4921014OtherExpensePriorYear
Other Expenses Current Year4872796OtherExpensesCurrentYear
Total Expenses Prior Year66917898TotalExpensesPriorYear
Total Expenses Current Year73132844TotalExpensesCurrentYear
Revenues Less Expenses Prior Year18607436RevenuesLessExpensesPriorYear
Revenues Less Expenses CY16141464RevenuesLessExpensesCY
Total Assets BOY190179949TotalAssetsBOY
Total Assets EOY205047764TotalAssetsEOY
Total Liabilities BOY3607334TotalLiabilitiesBOY
Total Liabilities EOY10705725TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY186572615NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY194342039NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE HEALTH & WELFARE BENEFITS TO MEMBERSMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense73098377Expense
Revenue88131713Revenue
DescriptionPROVIDE UNDER COLLECTIVE BARGAINING FINANCIAL SUPPORT FOR PROGRAMS OF LIFE INSURANCE, HEALTH, ACCIDENT, AND OTHER RELATED BENEFITS TO APPROXIMATELY 9,656 PARTICIPANTS.Description
Total Program Service Expense73098377TotalProgramServiceExpense
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096847NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees205NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJANETTA ENGLANDNamePerson
Telephone Number8122382551TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1413 SWAN STREETAddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code47807ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
FRANK DEGRAW
SEC-TREASURE0.00XX000
JACK BAKER
TRUSTEEX000
DOUGLAS S BANNING JR
TRUSTEEX000
TOM FLEENOR
TRUSTEEX000
BRIAN KRIEG
TRUSTEEX000
EDWARD T HAZLEDINE
CHAIRMANXX000
WILLIAM HASSE III
TRUSTEEX000
MARK STERN
TRUSTEEX000
WILLIAM K ROACH
TRUSTEEX000
DAVID FRYE
TRUSTEEX000
FRANCIS GANTER
TRUSTEEX000
JIM TERRY
TRUSTEEX000
MIKE MCCANN
TRUSTEEX000
JAMES W DANIELS
TRUSTEEX000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ANTHEM INC
220 VIRGINIA AVENUEINDIANAPOLISIN46204MED CLAIMS PROC2987306
SMITH GRAHAM & CO
6900 CHASE TOWER 600 TRAVIS STHOUSTONTX77002INVESTMENT MGR327459
DELTA DENTAL
PO BOX 30416LANSINGMI489097916DENT CLAIMS PRO268306
MED-CARE MANAGEMENT
PO BOX 20564WEST PALM BEACHFL334160564MED CLAIM REVIE258788
IFM GLOBAL INFRASTRUCTURE
99 PARK AVENUE SUITE 1920NEW YORKNY10016INVESTMENT FEES234600
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS5251007088598070885980
PARTICIPANT CONTRIBUTIONS52510081578328157832
ERRP REIMBURSEMENT52510010468781046878
ADMINISTRATIVE FEES525100718842718842
INTEREST ON CONTRIBUTIONS5251004022540225

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column31163TotalRevenueColumn
Related Or Exempt Function Income31163RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue80880920TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7267541TotalRevenueColumn
Related Or Exempt Function Income7267541RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities197903188Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities196777341Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1125847Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1125847TotalRevenueColumn
Related Or Exempt Function Income1125847RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column89274308TotalRevenueColumn
Related Or Exempt Function Income89274308RelatedOrExemptFunctionIncome

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total66040097Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total127462Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1316975Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total257833Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total335596Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total182085Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total61892Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38819Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9404Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total305238Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total56911Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total114807Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total16238Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total69747Total

Insurance Insurance

FieldValueIRS element (for citing)
Total23006Total

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotal
ANTHEM ACCESS FEES2987306
INVESTMENT EXPENSES749217
MED CARE MANAGEMENT FEES258788
ACTUARIAL FEES76500
OTHER ADMINISTRATIVE FEES63754

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total41169Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total73132844Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY12673228BOY
EOY11241812EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6291215BOY
EOY7210769EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY28456BOY
EOY28601EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2004546LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1323223LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY577004BOY
EOY681323EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY133337405BOY
EOY146543607EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY37272641BOY
EOY39341652EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY190179949BOY
EOY205047764EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3607334BOY
EOY2872714EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY7833011EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3607334BOY
EOY10705725EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY186572615BOY
EOY194342039EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY186572615BOY
EOY194342039EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY190179949BOY
EOY205047764EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses16141464ReconcilationRevenueExpenses
Reconcilation Other Changes-8372040ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis52103OtherCostOrOtherBasis
Book Value52103BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1524554OtherCostOrOtherBasis
Depreciation973317Depreciation
Book Value551237BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis427889OtherCostOrOtherBasis
Depreciation349906Depreciation
Book Value77983BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings681323TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
LIMITED PARTNERSHIPS17459097
GROUP ANNUITY INS. CONTRACT10808862
COLLECTIVE FUND9249308
MEDICARE PART D REIMBURSEMENT942661
ACCRUED INTEREST & DIVIDENDS812398
OTHER RECEIVABLES39725
ACCRUED INTEREST ON CONTRIBUTIONS29601
FieldValueIRS element (for citing)
Total Book Value Other Assets39341652TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
CLAIMS INCURRED BUT NOT REPORTED$7,150,004
DUE TO OTHER FUNDS$508,011
MEDICAL CLAIMS PAYABLE$174,996
FieldValueIRS element (for citing)
Total Of Amounts7833011TotalOfAmounts
Total Revenue89274308TotalRevenue
Total Expenses73132844TotalExpenses
Excess Or Deficit For Year16141464ExcessOrDeficitForYear
Net Unrealized GL On Investments-1047040NetUnrealizedGLOnInvestments
Total Adjustments-1047040TotalAdjustments
Excess Or Deficit Per FS15094424ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt86759209TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-1047040NetUnrealizedGainsInvestments
Revenue Not Rptd F990-1047040RevenueNotRptdF990
Revenue Subtotal87806249RevenueSubtotal
Investment Expenses Not Included749217InvestmentExpensesNotIncluded
Other Revenues Not Included718842OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1468059RevenueNotRptdOnFinStmt
Total Revenue Per Form99089274308TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt71664785TotExpensesEtcAuditedFinclStmt
Expenses Subtotal71664785ExpensesSubtotal
Investment Expenses Not Included2749217InvestmentExpensesNotIncluded2
Other Expenses Not Included718842OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1468059ExpensesNotRptdOnFinStmt
Total Expenses Per Form99073132844TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XTHE WELFARE FUND IS TAX EXEMPT UNDER INTERNAL REVENUE CODE PARAGRAPH 501 (C)(9). THE EXEMPTION RULING WAS OBTAINED MAY 10, 1957. THE WELFARE FUND OBTAINED ITS LATEST DETERMINATION LETTER ON JANUARY 11, 1983 IN WHICH THE INTERNAL REVENUE SERVICE STATED THAT THE PLAN, AS THEN DESIGNED, WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE PLAN HAS BEEN RESTATED AND AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN'S ADMINISTRATOR, LEGAL COUNSEL, AND CONSULTANT, BELIEVE THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, THEY BELIEVE THAT THE PLAN WAS QUALIFIED AND THE RELATED TRUST WAS TAX-EXEMPT AS OF THE FINANCIAL STATEMENT DATE. 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 THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE FUND, AND HAS CONCLUDED THAT AS OF NOVEMBER 30, 2011 AND NOVEMBER 30, 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE FUND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE FUND ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2008.
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8ADMINISTRATIVE FEES RECEIVED -718,842 ADMINISTRATIVE FEES RECEIVED 718,842
REVENUE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 4BADMINISTRATIVE FEES RECEIVED 718,842
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 4BADMINISTRATIVE FEES RECEIVED 718,842

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BFORM 990 IS REVIEWED BY THE SECRETARY-TREASURER PRIOR TO SIGNING AND FILING THE RETURN.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE TRUST FUND CONFORMS WITH ERISA RULES AND REGULATIONS WITH REGARD TO DISCLOSURE AND REVIEW OF POTENTIAL CONFLICTS OF INTEREST.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ACOMPENSATION FOR ALL EMPLOYEES IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BCOMPENSATION FOR ALL EMPLOYEES IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FUND PROVIDES A SUMMARY ANNUAL REPORT TO ALL PARTICIPANTS CONTAINING INSTRUCTIONS FOR OBTAINING A COPY OF THE FINANCIAL STATEMENTS AND FORM 5500.
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5FORM 990, PART I, LINE 21 - THE BALANCE OF NET ASSETS HAS BEEN REDUCED BY PREVIOUSLY EXISITING BALANCES THAT HAVE BEEN RECLASSIFIED AS LIABILITIES FOR THE TAX YEAR ENDED 11/30/2011 AS FOLLOWS: MEDICAL CLAIMS PAYABLE: 174,996 CLAIMS INCURRED BUT NOT REPORTED: 7,150,004