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WISCONSIN COUNTIES ASSOCIATION GROUP HEALTH TR: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WISCONSIN COUNTIES ASSOCIATION GROUP HEALTH TR (EIN 39-1692308)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-14
IRS object ID
201232279349303383
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-14T15:52:41-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8700AddressLine1
CityMADISONCity
StateWIState
ZIP Code537088700ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391692308EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN COUNTIES ASSOCIATION GROUP HEALTH TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWISCNameControl
Phone6086637188Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line122 E MIFFLIN NO 900AddressLine1
CityMADISONCity
StateWIState
ZIP Code53703ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMYRON SCHUSTERName
TitleCHAIRMANTitle
Phone6086637188Phone
Date Signed2012-07-17DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHEIDI KONKELName
PTINP00503121PTIN
Phone6082741980Phone
Date Prepared2012-07-17DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMYRON SCHUSTERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line122 E MIFFLIN SUITE 900AddressLine1
CityMADISONCity
StateWIState
ZIP Code53703ZIPCode
FieldValueIRS element (for citing)
Gross Receipts348324547GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.WCAGHT.ORGWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1991YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionPROVIDE HEALTH AND WELFARE BENEFITS TO WISCONSIN COUNTIES, SCHOOL DISTRICTS AND MUNICIPALITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year154547117ProgramServiceRevenuePriorYear
Program Service Revenue CY174126160ProgramServiceRevenueCY
Investment Income Prior Year745400InvestmentIncomePriorYear
Investment Income Current Year752146InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year155292517TotalRevenuePriorYear
Total Revenue Current Year174878306TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year15300GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15300GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year145796580BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY161961250BenefitsPaidToMembersCY
Salaries Etc Prior Year6300SalariesEtcPriorYear
Salaries Etc Current Year7200SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10929708OtherExpensePriorYear
Other Expenses Current Year12434617OtherExpensesCurrentYear
Total Expenses Prior Year156747888TotalExpensesPriorYear
Total Expenses Current Year174418367TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1455371RevenuesLessExpensesPriorYear
Revenues Less Expenses CY459939RevenuesLessExpensesCY
Total Assets BOY28991266TotalAssetsBOY
Total Assets EOY40387360TotalAssetsEOY
Total Liabilities BOY25564041TotalLiabilitiesBOY
Total Liabilities EOY36794054TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3427225NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3593306NetAssetsOrFundBalancesEOY
Mission DescriptionTO BE A COST EFFECTIVE RESOURCE FOR ASSISTING WISCONSIN COUNTIES AND OTHER LOCAL UNITS OF GOVERNMENT IN FULFILLING THEIR EMPLOYEE HEALTHCARE INSURANCE OBLIGATIONS IN A FISCALLY RESPONSIBLE MANNER.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPAYMENTS TO PROVIDE HEALTH AND WELFARE BENEFITS TO MEMBERS-REVENUE PROVIDES MEDICAL, DENTAL, AND VISION INSURANCE COVERAGE FOR PUBLIC EMPLOYEES COVERED UNDER THE WCA GHT SUMMARY PLAN. ALL PREMIUM REVENUES RECEIVED ARE FROM MEMBERS OF WCA GHT.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOSH BINDLBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6086637188TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line122 E MIFFLINAddressLine1
CityMADISONCity
StateWIState
ZIP Code53703ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MYRON SCHUSTER
CHAIRMAN4.00XX000
MARGARET BOSTELMANN
VICE-CHAIR4.00XX000
JOHN YOUNG
SECRETARY4.00XX110000
COLLEEN BATES
MEMBER4.00X100000
ALLEN BUECHEL
MEMBER4.00X60000
KEITH LANGENHAHN
MEMBER4.00X30000
HAL HELWIG
MEMBER4.00X100000
FRED PARENT
MEMBER4.00X60000
ANDY ROSS
MEMBER4.00X80000
LEE RYMER
MEMBER4.00X60000
GUS WIRTH JR
MEMBER4.00X60000
ROSEMARY RUECKERT
MEMBER4.00X60000
WARREN FLITCROFT
MEMBER4.00X000
LYNN NELSON
MEMBER4.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org7200TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDICAL EXCESS INSURANCE
PO BOX 3028COSTA MESACA92628INSURANCE BROKERS4698322
UMR
2700 MIDWEST DRONALASKAWI54650THIRD PARTY ADMINISTRATION SERVICES2759737
UNITED RESOURCE NETWORK
1400 FRONT AVENUE SUITE 300LUTHERVILLEMD21093INSURANCE BROKERS944055
WISCONSIN COUNTIES ASSOCIATION
22 E MIFFLIN ST STE 900MADISONWI53703CORPORATE MANAGEMENT SERVICES860728
AEGIS CORPORATION
18550 WEST CAPITOL DRIVEBROOKFIELDWI53405MARKETING CONSULTING SERVICES658417
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PREMIUMS524298174105195174105195
MISCELLANEOUS5242982096520965
FieldValueIRS element (for citing)
Total Program Service Revenue174126160TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column674831TotalRevenueColumn
Exclusion$674,831ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities173523556Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities173446241Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities77315Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column77315TotalRevenueColumn
Exclusion$77,315ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column174878306TotalRevenueColumn
Related Or Exempt Function Income174126160RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$752,146ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total15300Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total161961250Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total7200Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total843439Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total92370Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total23690Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total80551Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4814482Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total108698Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total48901Total

Insurance Insurance

FieldValueIRS element (for citing)
Total6333324Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
BANK SERVICE CHARGES50620
MISCELLANEOUS EXPENSE38542

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total174418367Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-10423BOY
EOY112385EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4474221BOY
EOY12416800EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY772323BOY
EOY1198732EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY867826BOY
EOY82661EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY21217697BOY
EOY24130416EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1669622BOY
EOY2446366EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY28991266BOY
EOY40387360EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY123658BOY
EOY317906EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY5236727BOY
EOY6139841EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY20203656BOY
EOY30336307EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25564041BOY
EOY36794054EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY3427225BOY
EOY3593306EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3427225BOY
EOY3593306EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28991266BOY
EOY40387360EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses459939ReconcilationRevenueExpenses
Reconcilation Other Changes-293858ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
U.S. GOVERNMENT SECURITIES8994096F
CORPORATE OBLIGATIONS11786588F
MUTUAL FUNDS3349732F
FieldValueIRS element (for citing)
Total Of Book Value Securities24130416TotalOfBookValueSecurities

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
CLAIM REIMBURSEMENT2273544
ACCRUED INTEREST172822
FieldValueIRS element (for citing)
Total Book Value Other Assets2446366TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
BENEFITS PAYABLE$29,561,620
LOSS ADJUSTING EXPENSE PAYABLE$774,687
FieldValueIRS element (for citing)
Total Of Amounts30336307TotalOfAmounts
Total Revenue174878306TotalRevenue
Total Expenses174418367TotalExpenses
Excess Or Deficit For Year459939ExcessOrDeficitForYear
Net Unrealized GL On Investments-293858NetUnrealizedGLOnInvestments
Total Adjustments-293858TotalAdjustments
Excess Or Deficit Per FS166081ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt168658589TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-293858NetUnrealizedGainsInvestments
Revenue Not Rptd F990-293858RevenueNotRptdF990
Revenue Subtotal168952447RevenueSubtotal
Investment Expenses Not Included80551InvestmentExpensesNotIncluded
Other Revenues Not Included5845308OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt5925859RevenueNotRptdOnFinStmt
Total Revenue Per Form990174878306TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt168492508TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal168492508ExpensesSubtotal
Investment Expenses Not Included280551InvestmentExpensesNotIncluded2
Other Expenses Not Included5845308OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt5925859ExpensesNotRptdOnFinStmt
Total Expenses Per Form990174418367TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE TRUST IS ORGANIZED AS A TAX-EXEMPT EMPLOYEE WELFARE BENEFIT TRUST UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE. THE TRUST IS ALSO EXEMPT FROM WISCONSIN FRANCHISE AND INCOME TAX. THE TRUST IS REQUIRED TO ASSESS WHETHER OR NOT IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF INFORMATION. IF THE TAX POSITIONS DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE TRUST HAS DETERMINED THERE ARE NO AMOUNTS TO RECORDS AS ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR THE TAX YEARS 2008, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BANK SERVICE CHARGES 50,620. RECLASSIFY REINSURANCE PREMIUMS 5,794,688.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:BANK SERVICE CHARGES 50,620. RECLASSIFY REINSURANCE PREMIUMS 5,794,688.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIP PROGRAMTypeOfGrant
Number Of Recipients5NumberOfRecipients
Amount Of Cash Grant15300AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE AVAILABLE TO CHILDREN OF EMPLOYEES OF GROUPS PARTICIPATING IN THE TRUST. SCHOLARSHIP CHECKS ARE SENT TO THE INDIVIDUAL BUT ARE MADE OUT TO BOTH THE INDIVIDUAL AND THE COLLEGE.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE TRUST HAS A THIRD-PARTY ADMINISTRATION AGREEMENT WITH UMR FOR GENERAL ADMINISTRATION OF THE TRUST. RESPONSIBILITIES OF THE ADMINISTRATOR UNDER THIS AGREEMENT INCLUDE PREPARATION OF PLAN DOCUMENTS AND AMENDMENTS, PARTICIPANT ENROLLMENT AND BILLING, PROCESSING PARTICIPANT BENEFIT CLAIMS, AND OTHER ADMINISTRATIVE SERVICES. THE TRUST HAS A CORPORATE MANAGEMENT AGREEMENT WITH WCA TO OVERSEE MARKETING OF THE TRUST, INVESTING TRUST ASSETS, MANAGING ALL SERVICES CONTRACTS AND PREPARATION OF MONTHLY FINANCIAL STATEMENTS, AS WELL AS PROVIDING ON GOING ADMINISTRATIVE SERVICES TO THE TRUST AND THE TRUST'S BOARD. THE TRUST HAS EMPLOYEE BENEFIT CONSULTING AND MARKETING CONTRACT WITH AEGIS CORPORATION. RESPONSIBILITIES OF AEGIS UNDER THIS AGREEMENT ARE TO MARKET THE PLANS TO MEMBER COUNTIES OF WCA AND CONSULT WITH THE TRUST AND UMR IN ESTABLISHING AND ADMINISTERING THE PLANS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7AMEMBER ORGANIZATIONS HAVE THE POWER TO APPOINT PERSONS RELATED TO THEIR OWN ORGANIZATION TO SIT ON THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11THE BOARD OF DIRECTORS CHAIRPERSON REVIEWS AND SIGNS THE RETURNS.
FORM 990, PART VI, SECTION B, LINE 12CWCA GROUP HEALTH REQUIRES OFFICERS AND KEY EMPLOYEES TO FILL OUT A DISCLOSURE FORM ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES DOCUMENTS AVAILABLE TO THE PUBLIC BY REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -293,858.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN COUNTIES ASSOCIATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line122 E MIFFLIN ST STE 900AddressLine1
CityMADISONCity
StateWIState
ZIP Code53703ZIPCode
FieldValueIRS element (for citing)
EIN396007681EIN
Primary ActivitiesREPRESENTS WI COUNTIES AT THE STATE AND FEDERAL LEVEL.PrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code SectionSEC 115ExemptCodeSection
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1WISCONSIN COUNTIES ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeOTransactionType
Amount Involved860728AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination