2017-03-10T15:13:50-06:00 2016-04-30 410746749 CliftonLarsonAllen LLP 227 West Trade Street Suite 800 Charlotte NC 28202 990 2015-05-01 356259970 IBA GROUP INSURANCE TRUST IBAG 8005586206 8910 PURDUE ROAD No 301 INDIANAPOLIS IN 46268 David W Blanford Trustee 8005586206 2017-03-07 John Norman P01506766 7049985200 2015 2021-01-29 14:40:06Z S Joe Dehaven 8910 PURDUE ROAD No 301 INDIANAPOLIS IN 46268 41950801 0 X N/A X 1957 IN To provide life, accident, and sickness benefits to eligible participants. 7 7 0 7 882850 805917 0 0 39427326 34097543 714146 882850 0 31879 40141472 35012272 0 0 33067538 43219198 0 0 0 0 0 5434249 1780981 38501787 45000179 1639685 -9987907 23122247 12177086 5162448 931337 17959799 11245749 To provide life, accident, and sickness benefits to eligible participants. 0 0 To provide life, accident, and sickness benefits to eligible participants. 0 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 1 0 0 0 1 1 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 IN X Capstone Administrators 3173287880 8910 Purdue Road Suite 301 Indianapolis IN 46268 X S Joe Dehaven Trustee 0.50 X 0 0 0 William F Ritzmann Trustee 0.50 X 0 0 0 Jack A Kenworthy Trustee 0.50 X 0 0 0 David W Blanford Trustee 0.50 X 0 0 0 Roger Cromer Trustee 0.50 X 0 0 0 Michael Mellon Trustee 0.50 X 0 0 0 Mark Fogt Trustee 0.50 X 0 0 0 0 0 0 0 0 0 0 Anthem 3350 Peachtree Road Atlanta GA 30326 Gen Plan Admn 3343661 Capstone Benefits Group 8910 Purdue Road Suite 240 Indianapolis IN 46268 Gen Plan Admn 1076070 Strategic Health Services 110 Samaritan Drive Suite 203 Cumming GA 30040 Gen Plan Admn 274545 Ogletree Deakins 111 Monument Circle Suite 4600 Indianapolis IN 46204 Legal Services 110551 4 Employer CONTRIBUTIONS 525100 33889216 33889216 Employee CONTRIBUTIONS 525100 208327 208327 34097543 484948 484948 7336431 6938529 397902 397902 397902 Income Tax Refund 900099 28370 28370 MISCELLANEOUS 900099 3509 3509 31879 35012272 34129422 882850 0 43219198 1453748 144005 26000 79493 15150 13507 40369 MISCELLANEOUS 8709 45000179 8589604 2379177 309454 455281 1048438 42008 10620 14181181 8283570 23122247 12177086 630236 140390 4532212 790947 5162448 931337 X 0 0 0 0 17959799 11245749 17959799 11245749 23122247 12177086 X -9987907 -1259640 4533497 X 0 1 X 1 0 0 Contributions Received in Advance 55403 Deposits for Future Claims 303795 Premium Stabilization Reserve 431749 790947 X 33673139 -1259640 -1259640 34932779 79493 79493 35012272 44920686 0 44920686 79493 79493 45000179 Part X, Line 2: The VEBA (Voluntary Employees Benefit Association) trust funding benefits of the Trust received an exemption letter from the Internal Revenue Service (IRS) dated May 20, 1974, stating that the trust is tax-exempt under the provisions of Section 501(c)9 of the Internal Revenue Code (IRC). However, as a result of the Trust's funding policy, from time to time the trust may be subject to income taxes. For the years ended April 30, 2016 and 2015, the Trust was subject to federal and state income taxes for unrelated business taxable income (UBTI) on certain investment income. UBTI is generated as a result of VEBA trust assets which exceed the amount reasonably necessary to cover unpaid accrued claims and premiums to insurance carriers, resulting in the excess accumulations being subject to UBTI. The tax is assessed on the lesser of the VEBA's income or excess assets in the qualified asset account. For UBTI purposes, the VEBA's income is equal to investment earnings, less investment management fees associated with those earnings. In addition, the Trust and the VEBA trust are required to operate in conformity with the IRC to maintain the tax-exempt status of the trust. The Trust administrator believes that the Trust is being operated in compliance with the applicable requirements of the IRC and, therefore, believes that the related VEBA trust is tax-exempt. Accounting principles generally accepted in the United States of America require Trust management to evaluate tax positions taken by the Trust and recognize a tax liability (or asset) if the Trust has taken an uncertain position that more likely than not would not be sustained upon examination by the IRS. The Trust is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Form 990, Part VI, Section A, line 3 IBA Group Insurance Trust delegates administration services to Principal Financial Group. Form 990, Part VI, Section B, line 11 Form 990 is reviewed annually by the Chairman of the Trustees and is available to each trustee prior to filing with the Internal Revenue Service. Form 990, Part VI, Section C, line 19 The Fund does not make its governing documents and financial statements available to the public. The Trust Fund and the Board of Trustees conform with ERISA rules and regulations relating to this matter. Form 990, Part XI, line 9: Prior Period Audit Adjustment 4533497. Anderson Partners LLC Ameriana Insurance Ameriana Savings Bank American Community Bank of Indiana Bank of Wolcott Bath State Bank Bedford Federal Savings Boonville Federal Savings Capstone Benefits Central Natl Bankattica Citizens Bank Citizens Exchange Claimaid Consulting Corp Community Bank Community Bank Royal Community First Bank of Indiana Community State Bank Community State Bank of SW Indiana Cremer Miller Crossroads Bank Dearborn Savings Fairmount St Bank Farmers & Mchanics SV GS Farmers & Merchants Farmers State Bank Brookston Federal Home Loan Bank First Bank Richmond First Fed S&L First Federal Savings Huntington First Federal Savings Evansville First Federal Savings Bank Angola First Federal Savings Rochester First Financial Corporation First Natl Bank of Monterey First Savings Bank Clarksville First State Bank First State Bank Porter Fountain Trust Co Garrett State Bank Graduate School of Banking Grant Co State Bank Harbour Trust & Investment Mgmt Co Hendricks County Bank Hoosier Heartland State Bank Horizon Bank Indiana Bankers Assoc Indiana Trust Company Jones McGlasson & Benckart PC Kentland Bank Kentland Federal Savings Lake City Bank Lake Federal Bank FSB Logansport Savings Bank Mid Southern Savings North Salem Bank Our Community Bank SB People's Bank Munster People's S&L Monticello People's Trust and Savings Riddell National Bank River Valley Financial Scottsburg Building Spencer Co Bank State Bank of Burnettsville Terre Haute Savings Bank The Farmers Bank The Napoleon State Bank Union S&L - Connersville United Community Bank Wayne Bank & Trust Co West End Bank SB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1