2011-10-17T07:59:24-05:00 2010-12-31 CLARK SCHAEFER HACKETT AND CO ONE EAST FOURTH ST SUITE 1200 CINCINNATI OH 45202 990 2010-01-01 311151537 BUTLER HEALTH PLAN BUTL 5138962300 400 NORTH ERIE BLVD NO B HAMILTON OH 45011 STEPHANIE HEARN 5139426262 2011-09-22 1 JANE E PFEIFER 5132413111 2011-09-22 2010 2016-03-07 17:11:31Z X STEPHANIE HEARN 1910 FAIRGROVE AVENUE SUITE C HAMILTON OH 45011 75951938 0 X WWW.BUTLERHEALTHPLAN.ORG X 1985 OH PROVIDE MEDICAL AND DENTAL BENEFITS FOR THE EXCLUSIVE BENEFIT OF ITS MEMBERS 7 7 2 0 0 0 0 0 63758100 75070315 1038691 881623 0 0 64796791 75951938 0 0 66677369 76310608 217430 236973 0 0 0 1756219 2854377 68651018 79401958 -3854227 -3450020 23033845 21063812 9425852 11046164 13607993 10017648 THE PLAN PROVIDES HEALTH (HOSPITAL, SURGICAL, MAJOR MEDICAL, AND PRESCRIPTION DRUG) AND DENTAL BENEFITS COVERING SUBSTANTIALLY ALL EMPLOYEES AND ELIGIBLE DEPENDENTS OF A CONSORTIUM OF SCHOOL DISTRICTS IN SOUTHWESTERN OHIO. 0 0 HEALTH CARE BENEFITS - PROVIDING HEALTH CARE COVERAGE TO PARTICIPATING SCHOOLS, SERVING APPROXIMATELY 6,400 INDIVIDUALS/FAMILIES. 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 0 1 2 0 1 2 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X STEPHANIE HEARN 5139426262 1910 FAIRGROVE AVENUE SUITE C HAMILTON OH 45011 DAN HARE 1.00 X X 0 0 0 ROBIN WHITE 1.00 X 0 0 0 JAN KESSELRING 1.00 X X 0 0 0 RICHARD PACKERT 1.00 X X 0 0 0 MARSHA MUEGGENBERG 1.00 X 0 0 0 NANCY LANE 1.00 X 0 0 0 CHRISTINE COOK-POETTER 1.00 X 0 0 0 STEPHANIE HEARN 40.00 X 113606 0 13824 113606 0 13824 1 0 0 0 ALLIED BENEFIT SYSTEMS INC 208 SOUTH LASALLE ST STE 1300 CHICAGO IL 60604 ADMINISTRATION FEES 1210128 FIFTH THIRD BANK 5050 KINGSLEY DRIVE CINCINNATI OH 45263 INVESTMENT SERVICES 115770 2 PARTICIPANT CONTRIBUTI 525100 75070315 75070315 75070315 881623 881623 75951938 75070315 0 881623 76310608 76310608 127430 127430 71726 71726 14994 14994 22823 22823 6002 6002 97003 97003 28600 28600 7500 7500 43621 43621 97683 97683 11012 11012 20549 20549 10507 10507 3846 3846 56893 56893 ADMINISTRATION FEES 2272183 2272183 WELLNESS & SUPPORT 78664 78664 BANK FEES 72149 72149 DUES & SUBSCRIPTIONS 19506 19506 MISCELLANEOUS 14715 14715 13944 13944 79401958 79401958 0 0 1472136 1244602 1050794 941200 20510915 18878010 23033845 21063812 1925852 2846164 7500000 8200000 9425852 11046164 X 0 0 0 0 13607993 10017648 13607993 10017648 23033845 21063812 X -3450020 -140325 X X 0 1 1 X 0 0 RESERVE ACCOUNT 8200000 8200000 75951938 79401958 -3450020 -140325 -140325 -3590345 75767992 -140325 -140325 75908317 43621 43621 75951938 78658337 0 78658337 43621 700000 743621 79401958 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 PLAN 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 PLAN, AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 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 PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2007. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN RESERVE BALANCE INCURRED BUT NOT REPORTED 700,000. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY GOVERNING COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE DIRECTOR OF THE ORGANIZATION BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS MUST STATE IF THERE ARE ANY POTENTIAL CONFLICTS. ADDITIONALLY, IF ANY CONFLICTS OCCUR DURING THE YEAR THE AFFECTED BOARD MEMBER MUST BRING THE CONFLICT BEFORE THE BOARD. THE BOARD MEMBER WITH THE POTENTIAL CONFLICT IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE PRINT COPIES OF ITS GOVERNING DOCUMENTS AT THE TIME OF REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -140,325. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS AN ANNUAL AUDIT OF THEIR FINANCIAL STATEMENTS AS PART OF COMPLIANCE WITH THE DEPARTMENT OF LABOR. THIS PROCESS HAS NOT CHANGED. FAIRFIELD CITY SCHOOL DISTRICT 211 DONALD DRIVE FAIRFIELD OH 45014 PUBLIC SCHOOLING OH 501(C)(1) 0 HAMILTON CITY SCHOOL DISTRICT 533 DAYTON STREET HAMILTON OH 45012 PUBLIC SCHOOLING OH 501(C)(1) 0 LAKOTA LOCAL SCHOOLS 5572 PRINCETON ROAD LIBERTY TOWNSHIP OH 45011 PUBLIC SCHOOLING OH 501(C)(1) 0 MIDDLETOWN CITY SCHOOLS 1515 GIRARD AVENUE MIDDLETOWN OH 45044 PUBLIC SCHOOLING OH 501(C)(1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAIRFIELD CITY SCHOOL DISTRICT R 9290061 CASH HAMILTON CITY SCHOOL DISTRICT R 9035242 CASH LAKOTA LOCAL SCHOOLS R 17001277 CASH MIDDLETOWN CITY SCHOOLS R 7333985 CASH