2014-11-14T16:16:30-06:00 2013-12-31 721088864 LAPORTE APAC 111 VETERANS MEMORIAL BLVD SUITE 600 METAIRIE LA 700054958 990 2013-01-01 720945796 COMMUNITY COFFEE COMPANY LLC EMPLOYEE HEALTH & LIFE BENEFITS PLAN COMM 2253683900 PO BOX 791 BATON ROUGE LA 708210791 ANNETTE VACCARO OFFICER 2253683900 2014-11-14 1 SEAN O'NEILL CPA P01061021 5048355522 2013 2015-11-30 17:44:51Z ANNETTE VACCARO PO BOX 791 BATON ROUGE LA 708210791 6228721 0 X N/A X 1997 LA PROVIDE TAX SHELTERED HEALTH AND LIFE BENEFITS TO EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC. 1 0 0 0 0 0 0 0 6695330 6228721 0 0 0 0 6695330 6228721 0 0 6095872 5631824 0 0 0 0 0 464466 596897 6560338 6228721 134992 0 715000 715000 1761333 2056969 -1046333 -1341969 TO PROVIDE THE EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC TAX SHELTERED HEALTH AND LIFE BENEFITS. 0 0 6228721 6228721 PROVIDE HEALTH AND LIFE BENEFITS TO EMPLOYEES OF COMMUNITY COFFEE COMPANY, LLC. 6228721 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 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X ANNETTE VACCARO 2252913900 3332 PARTRIDGE LANE BLDG A BATON ROUGE LA 70809 X COMMUNITY COFFEE COMPANY LLC TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 UNITED HEALTHCARE 3838 NORTH CAUSEWAY BLVD 2100 METAIRIE LA 70002 PLAN ADMINISTRATION 451048 WELLNET 3060 ROUTE 97 SUITE 290 GLENWOOD MO 21738 WELLNESS ADMINISTRATOR 120620 2 EMPLOYER CONTRIBUTIONS 900099 3835864 3835864 PARTICIPANT CONTRIBUTI 900099 2392857 2392857 6228721 6228721 6228721 0 0 5631824 596897 6228721 715000 715000 715000 715000 715000 650000 1046333 1406969 1761333 2056969 X 0 0 0 0 -1046333 -1341969 -1046333 -1341969 715000 715000 X 0 -295636 X 0 1 X 1 0 0 POST-RETIREMENT BENEFIT OBLIGATIONS 1406969 1406969 X 6228721 0 6228721 0 6228721 6228721 0 6228721 0 6228721 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN. MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2010. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 IS PROVIDED TO THE DIRECTOR OF ACCOUNTING AND TREASURY. IT IS REVIEWED FOR ACCURACY AND PROPRIETY. THE RETURN IS THEN REVIEWED BY THE CFO, WHO PROVIDES THE FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12 COMMUNITY COFFEE COMPANY, LLC EMPLOYEE HEALTH & LIFE BENEFITS PLAN DOES NOT HAVE THE POLICIES AND PROCEDURES AS NOTED ON PAGE 6, PART VI BECAUSE: 1. IT HAS NO EMPLOYEES OR BOARD OF DIRECTORS SO THERE IS NO ONE THE POLICIES WOULD APPLY TO. 2. IT IS A TRUST WHICH MERELY HOLDS FUNDS FOR EMPLOYEE AND RETIREE INSURANCE PAYMENTS. 3. COMMUNITY COFFEE COMPANY, LLC SERVES AS ITS TRUSTEE, WHICH HAS AN OUTSIDE FINANCIAL INSTITUTION TO MONITOR ITS INVESTMENTS AND AN OUTSIDE BOARD TO MONITOR COMPANY ACTIVITIES, POLICIES, AND PROCEDURES. 4. IT IS THE HEALTH AND LIFE BENEFITS PLAN OF COMMUNITY COFFEE COMPANY, LLC, WHICH HAS A CONFLICT OF INTEREST POLICY, A DOCUMENT RETENTION POLICY, A WHISTLEBLOWER POLICY, AND A COMPENSATION POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND TAX RETURNS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. HOWEVER, THE ORGANIZATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY. FORM 990, PART XI, LINE 9: CHANGE IN ACTUARIAL COMPUTATION -295,636. COMMUNITY COFFEE LLC PO BOX 791 BATON ROUGE LA 70821 720478429 SALES/DISTRIBUTION LA C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMUNITY COFFEE LLC L 3835864 FAIR MARKET VALUE