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ALLEGIANCE BENEFIT FOUNDATION INC: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
ALLEGIANCE BENEFIT FOUNDATION INC (EIN 20-1430196)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202203199349106910
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

FieldValueIRS element (for citing)
Return2022-11-15T14:55:23-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 EAST FRONT STREET 301AddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN201430196EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ALLEGIANCE BENEFIT FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlALLEBusinessNameControlTxt
Phone4065233118PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12806 S GARFIELD STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59801ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDIRK C VISSERPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone4065233118PhoneNum
Signature2022-11-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDIRKPersonFirstNm
Person LastVISSERPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSAM BRUNSON CPAPreparerPersonNm
PTINP01696998PTIN
Phone4067281800PhoneNum
Preparation2022-11-14PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$91,179FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$22,125ContriRcvdRevAndExpnssAmt
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$3,398OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$0OtherIncomeNetInvstIncmAmt
Total Rev And Expnss$25,523TotalRevAndExpnssAmt
Total Net Invst Incm$0TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Legal Fees Rev And Expnss$120LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Dsbrs Chrtbl$60LegalFeesDsbrsChrtblAmt
Other Expenses Rev And Expnss$1,314OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$0OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$657OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$1,434TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$0TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$717TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$25,500ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$25,500ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$26,934TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$0TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$26,217TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$1,411ExcessRevenueOverExpensesAmt
Net Investment Income$0NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$92,590CashBOYAmt
Cash EOY$91,179CashEOYAmt
Cash EOYFMV$91,179CashEOYFMVAmt
Total Assets BOY$92,590TotalAssetsBOYAmt
Total Assets EOY$91,179TotalAssetsEOYAmt
Total Assets EOYFMV$91,179TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind
Capital Stock BOY$0CapitalStockBOYAmt
Capital Stock EOY$0CapitalStockEOYAmt
Additional Paid In Capital BOY$0AdditionalPaidInCapitalBOYAmt
Additional Paid In Capital EOY$0AdditionalPaidInCapitalEOYAmt
Retained Earning BOY$92,590RetainedEarningBOYAmt
Retained Earning EOY$91,179RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$92,590TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$91,179TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$92,590TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$91,179TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$92,590TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$1,411ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$91,179SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$91,179TotNetAstOrFundBalancesEOYAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$0InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$0SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$0TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$0EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Tax Due$0TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateMTOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial ContributorsYes (1)NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1RICHARD DANIELSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4065233118PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line12806 S GARFIELD STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59801ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Transactions Fail To Qlfy As ExcYes (1)TransactionsFailToQlfyAsExcInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
DIRK C VISSER
2806 S GARFIELDMISSOULAMT59801PRESIDENT2.00$0$0$0
KIM VISSER
2806 S GARFIELDMISSOULAMT59801VICE PRESIDENT2.00$0$0$0
CLIFFORD G LARSEN
2806 S GARFIELDMISSOULAMT59801SECRETARY/TREASURER2.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$0AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$86,693AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$86,693TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$86,693AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,300CashDeemedCharitableAmt
Net Vl Noncharitable Assets$85,393NetVlNoncharitableAssetsAmt
Minimum Investment Return$4,270MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$4,270MinimumInvestmentReturnAmt
Total Tax$0TotalTaxAmt
Distributable Before Adj$4,270DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$4,270DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$4,270DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$26,217ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$26,217QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$4,270DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$31,090ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$58,833ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$69,903ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$47,942ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$4,955ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$212,723TotalExcessDistributionCyovAmt
Qualifying Distributions$26,217QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$4,270AppliedToCurrentYearAmt
Remaining Distri From Corpus$21,947RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$234,670TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$31,090ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$203,580ExcessDistriCyovToNextYrAmt
Excess From Year4$58,833ExcessFromYear4Amt
Excess From Year3$69,903ExcessFromYear3Amt
Excess From Year2$47,942ExcessFromYear2Amt
Excess From Year1$4,955ExcessFromYear1Amt
Excess From Current Year$21,947ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonALLEGIANCE BENEFIT FOUNDATIONRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line12806 S GARFIELD STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59801ZIPCd
FieldValueIRS element (for citing)
Recipient Phone4067212222RecipientPhoneNum
Form And Info And MaterialsAPPLICATION FOR SCHOLARSHIP COMPLETED BY APPLICANT.FormAndInfoAndMaterialsTxt
Submission DeadlinesNONESubmissionDeadlinesTxt
Restrictions On AwardsMUST DEMONSTRATE FINANCIAL NEED, HAVE A C+ GRADE POINT AVERAGE AND MUST BE PURSUING A DEGREE AT AN ACCREDITED COLLEGE OR UNIVERSITY IF APPLYING FOR AN ACADEMIC SCHOLARSHIP. MUST BE AN ORGANIZATION DESCRIBED UNDER CODE SECTION 501(C)(3) FOR CHARITABLE GRANTS.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (5 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
RENAISSANCE RANCH TREATMENT CENTER
2973 W 13800 SBLUFFDALEUT84065NONENCREQUEST FOR MEDICAL ASSISTANCE$8,500
SEAN TUPAS
44 MOULTRIE CTCOLUMBIASC29223NONEITO PROVIDE ASSISTANCE FOR CHILD HELATH EXPENSES$5,000
LEREMY STURM
4005 YORKSHIRE PLMISSOULAMT59808NONEITO PROVIDE ASSISTANCE FOR CHILD HELATH EXPENSES$5,000
BOBBY MARTIN
6113 SOUTH ROCKY RIVER RDMONROENC28112NONEITO PROVIDE ASSISTANCE FOR CHILD HELATH EXPENSES$5,000
UTAH STATE UNIVERSITY
1600 OLD MAIN HILLLOGANUT843221600NONEPCTO PROVIDE TUITION ASSISTANCE$2,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$25,500TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Net Income Loss From Special Evt NetIncomeLossFromSpecialEvtGrp

FieldValueIRS element (for citing)
Exclusion01ExclusionCd
Exclusion$2,084ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$2,084ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$2,084TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp (2 entries)

ContributorContributorNumAddress Line1ContributorUSAddress/AddressLine1TxtCityContributorUSAddress/CityNmState AbbreviationContributorUSAddress/StateAbbreviationCdZIPContributorUSAddress/ZIPCdTotal ContributionsTotalContributionsAmtPerson ContributionPersonContributionInd
DIRK VISSER
1PO BOX 2473MISSOULAMT59806$10,500Yes (X)
HCC LIFE INSURANCE COMPANY
2225 TOWNPARK DR 350KENNESAWGA30144$5,000Yes (X)

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$120LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$60DisbursementsCharitablePrpsAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp

FieldValueIRS element (for citing)
DescSPECIAL EVENT EXPENSESDesc
Revenue And Expenses Per Books$1,314RevenueAndExpensesPerBooksAmt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$657DisbursementsCharitablePrpsAmt

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescGROSS INCOME FROM SPECIAL FUNDRAISING EVENTSDesc
Revenue And Expenses Per Books$3,398RevenueAndExpensesPerBooksAmt
Adjusted Net Income$3,398AdjustedNetIncomeAmt

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCd
HCC LIFE INSURANCE COMPANY
225 TOWNPARK DR 350KENNESAWGA30144
DIRK VISSER
PO BOX 2473MISSOULAMT59806

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