2013-11-12T16:13:54-06:00 2012-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2012-01-01 363831874 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN MOSA 4028963884 4980 SOUTH 118TH STREET NO A OMAHA NE 68137 CYNTHIA L SCHROEDER 4028963884 2013-11-12 1 JULIE M GERKEN P00400882 4023302660 2012 2016-02-24 21:20:13Z CYNTHIA L SCHROEDER 4980 SOUTH 118TH STREET NO A OMAHA NE 68137 21723794 0 X NA X 1991 NE TO PROVIDE SELF-FUNDED HEALTH CARE, DENTAL CARE AND EDUCATION COMPENSATION BENEFITS TO PARTICIPANTS WHO ARE ELIGIBLE EMPLOYEES OR TO A COVERED DEPENDENT OF AN ELIGIBLE EMPLOYEE OF MOSAIC AND ITS AFFILIATES. 3 1 0 0 167280 0 0 0 19674479 21547757 189099 176037 0 0 19863578 21723794 0 0 16677946 18671398 0 0 0 0 0 2263012 2070992 18940958 20742390 922620 981404 15679707 17540526 2398802 3170251 13280905 14370275 TO PROVIDE SELF-FUNDED HEALTH CARE, DENTAL CARE AND EDUCATION COMPENSATIN BENEFITS TO PARTICIPANTS WHO ARE ELIGIBLE EMPLOYEES OR TO A COVERED DEPENDENT OF AN ELIGIBLE EMPLOYEE OR MOSAIC AND ITS AFFILIATES. 0 0 COMPREHENSIVE MEDICAL AND DENTAL CARE, EMPLOYEE ASSISTANCE WITH MENTAL AND NERVOUS DISORDERS AND EDUCATION COMPENSATION BENEFITS FOR ELIGIBLE EMPLOYEES AND DEPENDENTS. THERE WERE 3,041 ELIGIBLE EMPLOYEES, OF WHICH 2,936 WERE PARTICIPATING IN THE PLAN DURING THIS FISCAL YEAR. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 X 3 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 0 X CYNTHIA SCHROEDER 4028963884 4980 S 118TH ST SUITE A OMAHA NE 68137 LINDA TIMMONS 0.10 39.90 X X 0 438402 31676 CYNTHIA SCHROEDER 0.10 39.90 X X 0 395814 31811 GREAT WESTERN BANK 0.10 0.00 X 0 0 0 0 834216 63487 0 0 1 0 0 EMPLOYER CONTRIBUTIONS 525100 17726466 17726466 EMPLOYEES CONTRIBUTIONS 525100 3778291 3778291 EDUCATION INCOME 525100 43000 43000 21547757 167280 167280 8757 0 8757 8757 8757 21723794 21547757 167280 8757 18671398 1290454 8455 54634 54186 STOP LOSS PREMIUMS 458551 LIFE INSURANCE PREMIUMS 102723 WELLNESS 75709 CONVERSION EXPENSE 25176 1104 20742390 2620189 4990593 1765513 764676 11158 1537082 1851881 9756923 9922218 15679707 17540526 2398802 3170251 2398802 3170251 X 0 0 0 0 13280905 14370275 13280905 14370275 15679707 17540526 981404 107966 0 X 0 0 0 0 FIXED INCOME SECURITIES 9922218 F 9922218 0 0 0 LINDA TIMMONS 0 415824 0 10000 0 12578 0 17000 0 14676 0 470078 0 0 CYNTHIA SCHROEDER 0 331427 0 62251 0 2136 0 17135 0 14676 0 427625 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, LINE 3: THE COMPENSATION OF LINDA TIMMONS AND CINDY SCHROEDER ARE PAID FROM A RELATED ORGANIZATION, MOSAIC. MS. TIMMONS SERVES AS CEO OF MOSAIC, AND MS. SCHROEDER SERVES AS CFO OF MOSAIC. MS. TIMMONS SALARY IS SET BY THE MOSAIC COMPENSATION COMMITTEE AND MOSAIC BOARD OF DIRECTORS. MS. SCHROEDER'S SALARY IS SET BY THE CEO OF MOSAIC WORKING WITHIN THE SALARY RANGES ESTABLISHED BY THE COMPENSATION COMMITTEE. MOSAIC UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY / STUDY AND APPROVAL BY THE BOARD / COMPENSATION COMMITTEE IN ESTABLISHING THE COMPENSATION OF THE PRESIDENT AND CEO OF MOSAIC AND GUIDELINES FOR OTHER KEY STAFF. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND SUPPORTING SCHEDULES ARE PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FURTHERMORE, THE FORM 990 IS REVIEWED BY THE FINANCE DEPARTMENT OF MOSAIC, A RELATED ENTITY, PRIOR TO SUBMISSION OF THE FORM 990 TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS EACH TRUSTEE COMPLETES A CONFLICT OF INTEREST FORM AND SUBMITS IT TO THE CHAIRPERSON OF THE BOARD GOVERNANCE RISK AND INTEGRITY COMMITTEE. ANY FINANCIAL CONFLICTS OF INTEREST ARE REPORTED TO THE CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. ANY NEW CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR ARE REQUIRED TO BE REPORTED AT THAT TIME. MOSAIC EMPLOYEE WELFARE BENEFIT PLAN DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS, OR EMPLOYEES. THEREFORE, THERE IS NOT A PROCESS FOR DETERMINING COMPENSATION IN PLACE. FORM 990, PART VI, SECTION C, LINE 19 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII GREAT WESTERN BANK - 6015 RADIAL HWY, OMAHA, NE XXX-XX-XXXX. MOSAIC 4980 S 118 STREET LIND CENTER SUITE OMAHA NE 68137 113669999 SUPPORT INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES NE 501(C)(3) 9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 MOSAIC S 17215185 PREMIUM PAYMENTS