WISCONSIN SHEET METAL HEALTH AND BENEFIT TRUST FUND: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- WISCONSIN SHEET METAL HEALTH AND BENEFIT TRUST FUND (EIN 35-1638874)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-09-15
- IRS object ID
- 201102639349301005
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-09-15T15:12:35-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREYBERG HINKLE ASHLAND POWERS & STOWELL | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15420 W CAPITOL DR | AddressLine1 |
| City | BROOKFIELD | City |
| State | WI | State |
| ZIP Code | 530052621 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351638874 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN SHEET METAL WORKERS HEALTH | BusinessNameLine1 |
| Business Name Line2 | AND BENEFIT FUND | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WISC | NameControl |
| Phone | 4147780516 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 531862855 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICK LANDGRAF | Name |
| Title | CHAIRMAN | Title |
| Phone | 2627981818 | Phone |
| Date Signed | 2011-09-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES M ASHLAND CPA | Name |
| Phone | 2627846210 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PATRICK LANDGRAF | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 531862855 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 63976335 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 137 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26880340 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26415788 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1357854 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2523237 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 44765 | OtherRevenuePriorYear |
| Other Revenue Current Year | 34257 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 28282959 | TotalRevenuePriorYear |
| Total Revenue Current Year | 28973282 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 21848527 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 25421696 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 59212 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 43052 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3551431 | OtherExpensePriorYear |
| Other Expenses Current Year | 3808346 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 25459170 | TotalExpensesPriorYear |
| Total Expenses Current Year | 29273094 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2823789 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -299812 | RevenuesLessExpensesCY |
| Total Assets BOY | 47308989 | TotalAssetsBOY |
| Total Assets EOY | 47119329 | TotalAssetsEOY |
| Total Liabilities BOY | 16365310 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 16573158 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 30943679 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 30546171 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PROVIDE HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 25421696 | Expense |
| Description | HOSPITAL, SURGICAL, MEDICAL, DENTAL, VISION, AND PRESCRIPTION DRUG BENEFITS FOR APPROXIMATELY 2,770 MEMBERS AND THEIR FAMILIES | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 936756 | Expense |
| Description | PROVIDE SUPPLEMENTAL MEDICARE WRAPAROUND INSURANCE BENEFITS FOR APPROXIMATELY 750 MEMBERS | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 271983 | Expense |
| Description | PROVIDE MEDICAL CASE MANAGEMENT AND COST MANAGEMENT FOR APPROXIMATELY 2,000 MEMBERS | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 123800 | Expense |
| Description | LIFE INSURANCE AND COBRA PREMIUMS $79,287HSA CONTRIBUTIONS $44,513 | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 123800 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 26754235 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 437 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 137 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUZANNE TAZALLA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2627981838 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 531862855 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| PAT LANDGRAF | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| TODD BLAIR | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| ROGER JACKSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MIKE MOONEY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KEITH KEMPER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RANDALL KROCKA | ||||||
| TRUSTEE | 1.00 | X | X | 0 | 0 | 0 |
| BRIAN BILLMAN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| ROY STERN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DAVID BULTMAN | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| DAVID ALDAG | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KENNETH GROESCHEL | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| ROBERT JOSSART | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| PETER LENTZ | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RICHARD NORTHRUP | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DAVID SEITZ | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JEFFREY GAECKE | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BENEFIT PLAN ADMINISTRATORS | |||||
| 11270 W PARK PLACE SUITE 950 | MILWAUKEE | WI | 53224 | RECORDKEEPING AND PAYROLL AUDIT SERVICES | 736146 |
| UNITED HEALTHCARE | |||||
| 22703 NETWORK PLACE | CHICAGO | IL | 606731227 | MEDICAL CLAIMS ADMINISTRATION | 560921 |
| THE SEGAL COMPANY | |||||
| 101 N WACKER DRIVE SUITE 500 | CHICAGO | IL | 606061724 | ACTUARIAL SERVICES AND CONSULTING | 224434 |
| ANTHEM BLUE CROSS AND BLUE SHIELD | |||||
| 220 VIRGINIA AVENUE | INDIANAPOLIS | IN | 46204 | MEDICAL CLAIMS ADMINISTRATION | 165523 |
| REINHART BOERNER VAN DEUREN | |||||
| 1000 N WATER ST 1700 | MILWAUKEE | WI | 53202 | LEGAL SERVICES | 107805 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EMPLOYER CONTRIBUTIONS | 900099 | 21176265 | 21176265 |
| SELF-PAY CONTRIBUTIONS | 900099 | 4920679 | 4920679 |
| SASMI | 900099 | 318844 | 318844 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26415788 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1439437 | TotalRevenueColumn |
| Exclusion | $1,439,437 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 36086853 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 35003053 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1083800 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1083800 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1083800 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CONTRACTOR LATE CHARGE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 34257 | TotalRevenueColumn |
| Exclusion | $34,257 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 34257 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28973282 | TotalRevenueColumn |
| Related Or Exempt Function Income | 27499588 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,473,694 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25421696 | Total |
| Program Services | 25421696 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43052 | Total |
| Management And General | 43052 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 408766 | Total |
| Management And General | 408766 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145759 | Total |
| Management And General | 145759 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56290 | Total |
| Management And General | 56290 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90905 | Total |
| Management And General | 90905 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 224434 | Total |
| Management And General | 224434 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25346 | Total |
| Management And General | 25346 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35083 | Total |
| Management And General | 35083 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30064 | Total |
| Management And General | 30064 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10232 | Total |
| Management And General | 10232 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12808 | Total |
| Management And General | 12808 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99826 | Total |
| Program Services | 79287 | ProgramServices |
| Management And General | 20539 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| CLAIMS ADMINISTRATOR FE | 1344548 | 1344548 | |
| SMW PREMIUMS | 936756 | 936756 | |
| COST CONTAINMENT PROGRA | 271983 | 271983 | |
| HSA CONTRIBUTIONS | 44513 | 44513 | |
| BANK FEES | 33291 | 33291 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37742 | Total |
| Management And General | 37742 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29273094 | Total |
| Program Services | 26754235 | ProgramServices |
| Management And General | 2518859 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7764452 | BOY |
| EOY | 8971161 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1920798 | BOY |
| EOY | 2017082 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26266 | BOY |
| EOY | 28080 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 317605 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 269121 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37269 | BOY |
| EOY | 48484 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37230520 | BOY |
| EOY | 35750939 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 329684 | BOY |
| EOY | 303583 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47308989 | BOY |
| EOY | 47119329 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 761628 | BOY |
| EOY | 811724 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15603682 | BOY |
| EOY | 15761434 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16365310 | BOY |
| EOY | 16573158 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30943679 | BOY |
| EOY | 30546171 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30943679 | BOY |
| EOY | 30546171 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47308989 | BOY |
| EOY | 47119329 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -299812 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -97696 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 317605 | OtherCostOrOtherBasis |
| Depreciation | 269121 | Depreciation |
| Book Value | 48484 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 48484 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED HEALTH CLAIMS PAYABLE AND IBNR | $2,593,900 |
| ACCUMULATED BENEFITS - PARTICIPANTS | $12,586,842 |
| DUE TO OTHER FUNDS | $580,692 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15761434 | TotalOfAmounts |
| Total Revenue | 28973282 | TotalRevenue |
| Total Expenses | 29273094 | TotalExpenses |
| Excess Or Deficit For Year | -299812 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -97696 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -97696 | TotalAdjustments |
| Excess Or Deficit Per FS | -397508 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 28784681 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -97696 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -97696 | RevenueNotRptdF990 |
| Revenue Subtotal | 28882377 | RevenueSubtotal |
| Investment Expenses Not Included | 90905 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 90905 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 28973282 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 29038192 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 29038192 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 90905 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 143997 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 234902 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 29273094 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE FUND ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2010 THERE ARE NO UNCERTAIN POSITIONS. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | INCREASE IN HEALTH CLAIMS PAYABLE AND CLAIMS INCURRED BUT NOT REPORTED -541,100. DECREASE IN ACCUMULATED BENEFITS FOR PARTICIPANTS 685,097. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEWED BY THE ADMINISTRATIVE MANAGER AND PRESENTED TO TRUSTEES FOR APPROVAL PRIOR TO SIGNING AND FILING. | |
| TRUSTEES ARE EXPECTED TO DISCLOSE ANY OWNERSHIP OR OTHER FINANCIAL RELATIONSHIPS THAT THEY HAVE WITH PARTIES THAT DEAL WITH THE PLAN. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE PLAN OFFICE. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -97,696. | FORM 990, PART XI, LINE 5: |
| THE BOARD OF TRUSTEES REVIEWS AND APPROVES A DRAFT OF THE AUDITED FINANCIAL STATEMENTS AT THE MEETING. THESE ARE PRESENTED BY THE ACCOUNTANT TO THE BOARD. | PART XII, LINE 2C | |
| THE $(397,508) REPORTED HERE ON LINE 10 DOES NOT AGREE WITH THE NET INCREASE IN NET ASSETS AVAILABLE FOR BENEFITS PER THE AUDITED FINANCIAL STATEMENTS OF $(253,511). THE DIFFERENCE OF $143,997 IS THE SUM OF THE CHANGES IN BENEFITS PAYABLE OF $(541,100) AND THE ACCUMULATED BENEFIT FOR PARTICIPANTS OF $685,097. THESE ITEMS ARE INCLUDED IN THE FORM 990, BUT ARE ONLY DISCLOSED IN THE NOTES OF THE AUDITED FINANCIAL STATEMENTS. | FORM 990, SCHEDULE D, PART XI, LINE 10 |