WV - OH SUPPLEMENTAL HEALTH PLAN: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WV - OH SUPPLEMENTAL HEALTH PLAN (EIN 30-0002072)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-24
- IRS object ID
- 202212369349300701
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-24T06:57:32-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550526247 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KOZICKI HUGHES TICKERHOOF PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32 TWENTIETH STREET SUITE 300 | AddressLine1Txt |
| City | WHEELING | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300002072 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WV-OH SUPPLEMENTAL HEALTH PLAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WV-O | BusinessNameControlTxt |
| Phone | 3045250331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3150 US ROUTE 60 | AddressLine1Txt |
| City | ONA | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25545 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACKSON ELKINS | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 3045250331 | PhoneNum |
| Signature | 2022-08-22 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JACKSON | PersonFirstNm |
| Person Last | ELKINS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NANCY HUGHES CPA | PreparerPersonNm |
| PTIN | P01447261 | PTIN |
| Phone | 3042322280 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JONATHAN MANDI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 939 GOODALE BLVD SUITE 204 | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,736,981 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | NA | WebsiteAddressTxt |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING SUPPLEMENTAL HEALTH PREMIUMS AND WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,475,772 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,673,956 | CYProgramServiceRevenueAmt |
| PY Investment Income | $109,783 | PYInvestmentIncomeAmt |
| CY Investment Income | $152,443 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,585,555 | PYTotalRevenueAmt |
| CY Total Revenue | $1,826,399 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $1,432,193 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $1,385,794 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $70,239 | PYOtherExpensesAmt |
| CY Other Expenses | $70,581 | CYOtherExpensesAmt |
| PY Total Expenses | $1,502,432 | PYTotalExpensesAmt |
| CY Total Expenses | $1,456,375 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $83,123 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $370,024 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,777,611 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,175,613 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,050 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $62,036 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,757,561 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,113,577 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE SUPPLEMENTAL HEALTH PREMIUMS & WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS (IBEW) UNIONS | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,323,917 | ExpenseAmt |
| Desc | THE PROVISION OF SUPPLEMENTAL HEALTH INSURANCE PREMIUMS FOR ELIGIBLE MEMBERS OF THE PARTICIPATING LOCAL IBEW UNIONS | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $61,877 | ExpenseAmt |
| Desc | THE PROVISION OF SUPPLEMENTAL DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING IBEW LOCAL UNIONS | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,385,794 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMERICAN BENEFIT CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3045250331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3150 US ROUTE 60 | AddressLine1Txt |
| City | ONA | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| TROY FERRELL | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHANE FERGUSON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| THOMAS CONNER | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHRIS SAMPLES | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JEFFERY BURGE | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WILLIAM HAMILTON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| BILL LEMASTERS | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BRUCE LAWSON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JASON BLUE | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHNATHAN MANDL | ||||||
| TRUSTEE - SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES BANE | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CODY PALMER | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EMPLOYER CONTRIBUTIONS | Desc |
| Business | 525100 | BusinessCd |
| Total Revenue Column | $1,673,956 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,673,956 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,673,956 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,025 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $106,025 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,957,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,910,582 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $46,418 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,418 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,418 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,826,399 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,826,399 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,385,794 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,200 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,541 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,456 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,916 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,663 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,774 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,031 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,456,375 | TotalAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,315 | BOYAmt |
| EOY | $136,143 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,969 | BOYAmt |
| EOY | $162,295 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,850 | BOYAmt |
| EOY | $117,591 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,168,663 | BOYAmt |
| EOY | $3,734,187 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,814 | BOYAmt |
| EOY | $25,397 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,777,611 | BOYAmt |
| EOY | $4,175,613 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,050 | BOYAmt |
| EOY | $62,036 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,050 | BOYAmt |
| EOY | $62,036 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,757,561 | BOYAmt |
| EOY | $4,113,577 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,757,561 | BOYAmt |
| EOY | $4,113,577 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,777,611 | BOYAmt |
| EOY | $4,175,613 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $370,024 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$14,008 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,785,475 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$14,009 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$26,916 | OtherRevenueAmt |
| Revenue Not Reported | -$40,925 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,826,400 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,826,400 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,429,459 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$26,916 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$26,916 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,456,375 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,456,375 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d - Other Adjustments: | INVESTMENT EXPENSES SHOWN NET OF REVENUE -26,916. |
| Part XII, Line 2d - Other Adjustments: | INVSETMENT EXPENSES SHOWN NET OF REVENUE -26,916. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | THE TRUSTEES FOR THE FUND ENGAGED AMERICAN BENEFIT CORPORATION TO PROVIDE ADMINISTRATIVE SERVICES FOR THE PLAN EFFECTIVE 1/1/2007. |
| Form 990, Part VI, Section B, line 11b | THE ORGANIZATION'S FORM 990 IS PREPARED ANNUALLY BY AN INDEPENDENT ACCOUNTING FIRM. THE FIRM SENDS A DRAFT TO THE ONE OR MORE MEMBERS OF THE GOVERNING BODY TO BE DISTRIBUTED TO THE REMAINING MEMBERS BEFORE THE FORM IS SIGNED BY AN AUTHORIZED MEMBER AND FILED WITH THE APPROPRIATE TAX AUTHORITIES. |
| Form 990, Part VI, Section C, line 19 | THIS 990 IS ALWAYS PUBLICALLY AVAILABLE THROUGH GUIDESTAR.COM; HOWEVER, THE PLAN'S GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS ARE ONLY AVAILABLE UPON REQUEST TO INTERESTED PARTIES. |
| PART XII, LINE 2C EXPLANATION | THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE R PART VII SUPPLEMENTAL INFORMATION | BusinessNameLine1Txt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE R PART VII SUPPLEMENTAL INFORMATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART II, III & IV | FormAndLineReferenceDesc |
| Explanation | SCHEDULE R, PARTS II-IV. CONTRIBUTING EMPLOYERS AND ALL OTHER NECESSARY INFORMATION IS MAINTAINED WITHIN THE ORGANIZATION AND IS AVAILABLE UPON REQUEST FOR ANY INTERESTED PARTY. | ExplanationTxt |
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