2022-11-03T11:05:10-05:00 2021-12-31 340677006 MALONEY NOVOTNY LLC 1111 SUPERIOR AVE SUITE 700 CLEVELAND OH 441142540 990 2021-01-01 820907005 MISSOURI CHAMBER FEDERATION BENEFIT PLAN TRUST MISS 5736343511 428 EAST CAPITOL AVENUE 100 JEFFERSON CITY MO 65101 BRENDAN COSSETTE PLAN ADMINISTRATOR 5736343511 2022-11-03 1 BRENDAN COSSETTE 999009999 CHRISTOPHER B ANDERSON P00226559 2163630100 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DAN MEHAN 428 EAST CAPITOL AVENUE 100 JEFFERSON CITY MO 65101 154906517 0 X N/A X 2017 MO THE ORGANIZATION IS A MULTIPLE EMPLOYER WELFARE ARRANGEMENT WHICH PROVIDES SELF-FUNDED MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR ITS MEMBERS. 5 5 0 0 4621 0 0 0 115557959 154901896 28556 4621 0 0 115586515 154906517 0 0 99942918 135914811 0 0 0 0 0 14705885 18261190 114648803 154176001 937712 730516 15708246 21127106 11866751 16555095 3841495 4572011 THE ORGANIZATION IS A MULTIPLE EMPLOYER WELFARE ARRANGEMENT WHICH PROVIDES SELF-FUNDED MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR ITS MEMBERS. 0 0 THE MISSOURI CHAMBER FEDERATION BENEFIT PLAN TRUST PROVIDED SELF-FUNDED HEALTH AND WELFARE BENEFITS TO PARTICIPATING EMPLOYERS AND THEIR ELIGIBLE EMPLOYEES. PARTICIPATING EMPLOYERS ARE REQUIRED TO BE MEMBERS IN GOOD STANDING WITH A CHAMBER OF COMMERCE BELONGING TO THE MISSOURI CHAMBER FEDERATION. EACH PARTICIPATING EMPLOYER SPONSORS THEIR OWN BENEFIT PLAN. 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 0 0 0 1 1 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X BRENDAN COSSETTE 5736343511 428 E CAPITOL AVE 100 JEFFERSON CITY MO 65101 X DAN MEHAN TRUSTEE & CHAIRPERSON 1.00 X 0 0 0 RON FITZWATER TRUSTEE 1.00 X 0 0 0 CHUCK BOWMAN TRUSTEE 1.00 X 0 0 0 FRANK BURKHEAD TRUSTEE 1.00 X 0 0 0 BRENDAN COSSETTE PLAN ADMINISTRATOR 1.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM BLUE CROSS BLUE SHIELD 1831 CHESTNUT ST ST LOUIS MO 63103 CONTRACT MANAGEMENT 12089128 CONSOLIPLEX MISSOURI 9555 ROCKSIDE RD STE 300-C CLEVELAND OH 44125 MANAGEMENT SERVICES 1656655 MARSH & MCLENNAN COMPANIES INC 6480 ROCKSIDE WOODS BLVD S STE 2 INDEPENDENCE OH 44131 GENERAL CONSULTING 486638 THP INSURANCE COMPANY 1110 MAIN ST WHEELING WV 26003 ADMINISTRATIVE SERVICES 389103 REFORM LABS INC 1633 QUEENS COURT WESTLAKE OH 44145 INFORMATION MANAGEMENT 153239 5 EMPLOYEE&EMPLOYER CONTRIB. 525100 154901896 154901896 154901896 4621 4621 154906517 154901896 4621 0 135914811 14924340 23800 4953 830 114306 REGULATORY FEES 3192594 FEDERAL INCOME TAX 367 154176001 12562198 13917575 3633387 3629209 166978 320575 129617 90066 -783934 3169681 15708246 21127106 1988915 2621314 9877836 13933781 11866751 16555095 X 3841495 4572011 3841495 4572011 15708246 21127106 730516 0 X 0 1 X 1 0 0 REINSURANCE RECEIVABLE 3169681 3169681 REINSURANCE AMOUNTS PAYABLE - PER 13933781 13933781 X 154901564 0 154901564 4953 4953 154906517 154171048 0 154171048 4953 4953 154176001 PART X, LINE 2: FIN 48/ASC 740 FOOTNOTE - THE TRUST'S MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE TRUST AND HAS CONCLUDED THAT, AS OF MAY 31, 2021 (THE YEAR-END OF THE ERISA WELFARE BENEFIT PLAN), 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 TRUST IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI AND XII - ADDITIONAL INFO.ABOUT FIN.STATEMENTS: AS FURTHER EXPLAINED ON SCHEDULE O, THE TRUST HAS AUDITED FINANCIAL STATEMENTS ISSUED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) FOR THE WELFARE PLAN'S YEAR ENDED MAY 31. THE TRUST ALSO HAS AUDITED FINANCIAL STATEMENTS ISSUED ON THE BASIS OF INSURANCE STATUTORY ACCOUNTING FOR THE CALENDAR YEAR. THE INFORMATION PRESENTED IN PARTS XI AND XII AS IF THE TRUST HAD AUDITED GAAP FINANCIAL STATEMENTS FOR THE CALENDAR YEAR. FORM 990, PART IV, LINE 12A - FINANCIAL STATEMENTS: THE TRUST HAS AUDITED FINANCIAL STATEMENTS UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP), BUT THE FINANCIAL STATEMENTS ARE PRESENTED ON THE BASIS OF THE ERISA WELFARE PLAN'S YEAR-END OF MAY 31, 2021. AN INSURANCE ENTITY LIKE THIS MULTIPLE EMPLOYER WELFARE ARRANGEMENT IS GENERALLY REQUIRED TO UTILIZE A CALENDAR YEAR FOR STATUTORY ACCOUNTING PURPOSES. THE TRUST HAS BOTH AN ERISA AND A STATUTORY AUDIT CONDUCTED ANNUALLY. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE ORGANIZATION - THE MEMBERS OF THE ORGANIZATION ARE THE PARTICIPATING EMPLOYERS IN THE MULTIPLE EMPLOYER WELFARE ARRANGEMENT. FORM 990, PART VI, SECTION A, LINE 7A POWERS OF THE MEMBERS - THE MEMBERS, WHO ARE PARTICIPATING EMPLOYERS IN THE PLAN, ELECT THE TRUSTEES IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS. THE BOARD OF TRUSTEES GOVERNS THE PLAN. THEY SERVE THREE-YEAR STAGGERED TERMS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW - THE OUTSIDE PUBLIC ACCOUNTING FIRM REVIEWS THE DRAFT FORM 990 PROVIDED BY THE PLAN MANAGER AND REPORTS TO THE PLAN'S TRUSTEE-CHAIRPERSON. AFTER REVIEW AND APPROVAL BY THE TRUSTEE-CHAIRPERSON, FORM 990 IS SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF CONFLICT POLICY - EACH TRUSTEE MUST REPORT WHETHER HE/SHE HAS ANY INTEREST IN ANY PARTY DOING BUSINESS WITH THE TRUST. THE TRUSTEE CODE OF CONDUCT IS SIGNED BY EACH TRUSTEE. THE CASH MANAGEMENT SYSTEM DOES NOT ALLOW FOR ACH DISBURSEMENTS OF PLAN ASSETS TO TRUSTEES OF FIDUCIARIES. THE PROCEDURE FOR CUTTING CHECKS REQUIRES SIGNOFF BY ALL TRUSTEES WITH EXTERNAL REVIEW BY ACCOUNTANTS AND/OR ATTORNEYS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS - THE TRUST'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST TO ANY PARTICIPATING BANK OR INDIVIDUAL PLAN PARTICIPANT. NOTICES ARE SENT TO INTERESTED PARTIES WHEN THE ANNUAL REPORTS ARE COMPLETE. 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