LYCOMING COUNTY INSURANCE CONSORTIUM POOLED TR: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
LYCOMING COUNTY INSURANCE CONSORTIUM POOLED TR (EIN 23-2929129)
Tax period
2020-07-01 to 2021-06-30
Filed
2021-11-12
IRS object ID
202103169349307200
Schema version
2020v4.0
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)
Return2021-11-12T12:36:56-06:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN232723863PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1LARSON KELLETT & ASSOCIATES PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line140 CHOATE CIRCLEAddressLine1Txt
CityMONTOURSVILLECityNm
State AbbreviationPAStateAbbreviationCd
ZIP17754ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN232929129EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LYCOMING COUNTY INSURANCEBusinessNameLine1Txt
Business Name Line2CONSORTIUM POOLED TRUSTBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlLYCOBusinessNameControlTxt
Phone5706736001PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line133 SPRINGBROOK DRIVEAddressLine1Txt
CityCANTONCityNm
State AbbreviationPAStateAbbreviationCd
ZIP17724ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSARA MCNETTPersonNm
Person TitleTREASURERPersonTitleTxt
Phone5706736001PhoneNum
Signature2021-11-12SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstSARAPersonFirstNm
Person LastMCNETTPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRANDALL S DIPALOPreparerPersonNm
PTINP00358387PTIN
Phone5703682941PhoneNum
Preparation2021-11-12PreparationDt
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSARA MCNETTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line133 SPRINGBROOK DRIVEAddressLine1Txt
CityCANTONCityNm
State AbbreviationPAStateAbbreviationCd
ZIP17724ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$41,902,939GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1997FormationYr
Legal Domicile StatePALegalDomicileStateCd
Activity Or MissionTO INCREASE PURCHASING LEVERAGE FOR HEALTH CARE PREMIUM COSTS AND POOL RISKS FOR THE ELIGIBLE EMPLOYEES OF PARTICIPATING EDUCATIONAL INSTITUTIONS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$43,990,505PYProgramServiceRevenueAmt
CY Program Service Revenue$41,587,171CYProgramServiceRevenueAmt
PY Investment Income$430,177PYInvestmentIncomeAmt
CY Investment Income$315,753CYInvestmentIncomeAmt
PY Other Revenue$24PYOtherRevenueAmt
CY Other Revenue$15CYOtherRevenueAmt
PY Total Revenue$44,420,706PYTotalRevenueAmt
CY Total Revenue$41,902,939CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$32,272,263PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$37,099,852CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,875,556PYOtherExpensesAmt
CY Other Expenses$1,798,114CYOtherExpensesAmt
PY Total Expenses$34,147,819PYTotalExpensesAmt
CY Total Expenses$38,897,966CYTotalExpensesAmt
PY Revenues Less Expenses$10,272,887PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,004,973CYRevenuesLessExpensesAmt
Total Assets BOY$29,852,273TotalAssetsBOYAmt
Total Assets EOY$32,857,246TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$29,852,273NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$32,857,246NetAssetsOrFundBalancesEOYAmt
MissionTO INCREASE PURCHASING LEVERAGE FOR HEALTH CARE PREMIUM COSTS AND POOL RISKS FOR THE ELIGIBLE EMPLOYEES OF PARTICIPATING EDUCATIONAL INSTITUTIONS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$38,867,518ExpenseAmt
Revenue$41,587,171RevenueAmt
DescPROVIDED A PROGRAM OF HEALTH AND WELFARE BENEFITS FOR ITS PARTICIPANTS.Desc
Total Program Service Expenses$38,867,518TotalProgramServiceExpensesAmt
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSARA MCNETTPersonNm
Phone5706736001PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line133 SPRINGBROOK DRIVEAddressLine1Txt
CityCANTONCityNm
State AbbreviationPAStateAbbreviationCd
ZIP17724ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
HEATHER BURKE
DIRECTORYes (X)$0$0$0
ERIC BUTLER
DIRECTORYes (X)$0$0$0
DAN EGLY
DIRECTORYes (X)$0$0$0
BENJAMIN ENDERS
DIRECTORYes (X)$0$0$0
WANDA ERB
DIRECTORYes (X)$0$0$0
GRANT EVANGELISTI
DIRECTORYes (X)$0$0$0
JAMIE MOWREY
DIRECTORYes (X)$0$0$0
ANDREW SEESE
VICE CHAIRYes (X)$0$0$0Yes (X)
BRANDY SMITH
CHAIRYes (X)$0$0$0Yes (X)
SUZANNE STOPPER
DIRECTORYes (X)$0$0$0
SARA MCNETT
TREASURER$0$0$0Yes (X)
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmtAddress Line2ContractorAddress/USAddress/AddressLine2Txt
HIGHMARK BLUE SHIELD
19 NORTH MAIN STREETWILKESBARREPA18711CLAIMS ADMIN$1,351,164
USI INSURANCE SERVICES LLC
100 SUMMIT LAKE DRIVEVALHALLANY10595INSURANCE$123,742SUITE 400
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescCONTRIBUTIONS FROM MEMBERSDesc
Total Revenue Column$41,587,171TotalRevenueColumnAmt
Related Or Exempt Func Income$41,587,171RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$41,587,171TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$315,753TotalRevenueColumnAmt
Exclusion$315,753ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISC REVENUEDesc
Total Revenue Column$15TotalRevenueColumnAmt
Exclusion$15ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$15OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,902,939TotalRevenueColumnAmt
Related Or Exempt Func Income$41,587,171RelatedOrExemptFuncIncomeAmt
Exclusion$315,768ExclusionAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$37,099,852TotalAmt
Program Services$37,099,852ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,508TotalAmt
Management And General$7,508ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,545,320TotalAmt
Program Services$1,545,320ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$22,940TotalAmt
Management And General$22,940ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
WELLNESS INCENTIVE PROGS$215,400$215,400
HEALTHCARE LEG REFORM FEE$6,946$6,946

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$38,897,966TotalAmt
Program Services$38,867,518ProgramServicesAmt
Management And General$30,448ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$29,852,273BOYAmt
EOY$32,857,246EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$29,852,273BOYAmt
EOY$32,857,246EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$29,852,273BOYAmt
EOY$32,857,246EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,852,273BOYAmt
EOY$32,857,246EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,852,273BOYAmt
EOY$32,857,246EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,004,973ReconcilationRevenueExpnssAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 7ATHE ORGANIZATION HAS MEMBERS WHO CAN ELECT MEMBERS OF GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 7BTHERE ARE DECISIONS OF THE GOVERNING BODY THAT ARE SUBJECT TO APPROVAL BY MEMBERS.
FORM 990, PAGE 6, PART VI, LINE 11BTREASURER REVIEWS THE FORM 990 ON BEHALF OF THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 19AVAILABLE VIA PUBLIC RECORDS AT BLAST INTERMEDIATE UNIT 17, 33 SPRINGBROOK DRIVE, CANTON, PA 17724.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
EAST LYCOMING SCHOOL DISTRICT
349 CEMETERY STREETHUGHESVILLEPA17737231667965EDUCATIONPANAfalse
JERSEY SHORE AREA SCHOOL DISTRICT
175 AP DRIVEJERSEY SHOREPA17740246002552EDUCATIONPANAfalse
LOYALSOCK TOWNSHIP SCHOOL DISTRICT
1605 FOUR MILE DRIVEWILLIAMSPORTPA17701246001067EDUCATIONPANAfalse
LYCOMING CAREER & TECHNOLOGY CENTER
293 CEMETERY STREETHUGHESVILLEPA17737232647841EDUCATIONPANAfalse
MONTGOMERY AREA SCHOOL DISTRICT
120 PENN STREETMONTGOMERYPA17752246001106EDUCATIONPANAfalse
MUNCY SCHOOL DISTRICT
206 SHERMAN STREETMUNCYPA17756246001124EDUCATIONPANAfalse
PENNSYLVANIA COLLEGE OF TECHNOLOGY
1 COLLEGE AVEWILLIAMSPORTPA17701232564508EDUCATIONPANAfalse
S WILLIAMSPORT AREA SCHOOL DISTRIC
515 WEST CENTRAL AVESOUTH WILLIAMSPORTPA17702246002560EDUCATIONPANAfalse
MONTOURSVILLE AREA SCHOOL DISTRICT
50 NORTH ARCH STREETMONTOURSVILLEPA17754231667972EDUCATIONPANAfalse
WILLIAMSPORT AREA SCHOOL DISTRICT
2780 WEST FOURTH STREETWILLIAMSPORTPA17701240859746EDUCATIONPANAfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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