WISCONSIN FOX RIVER VALLEY SHEET METAL WORKERS WELFARE TRUST: Form 990, tax year 2010
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- Organization
- WISCONSIN FOX RIVER VALLEY SHEET METAL WORKERS WELFARE TRUST (EIN 39-6095127)
- Tax period
- 2010-06-01 to 2011-05-31
- Filed
- 2012-04-02
- IRS object ID
- 201220939349300322
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-04-02T10:47:39-05:00 | Timestamp |
| Tax Period End Date | 2011-05-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAUMAN ASSOCIATES LTD | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1225 | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 547021225 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-06-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 396095127 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FOX VALLEY SHEET METAL HEALTH FUND | BusinessNameLine1 |
| Business Name Line2 | C/O BENEFIT PLAN ADMINISTRATION | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FOXV | NameControl |
| Phone | 4145773700 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53186 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PRESIDENT | Name |
| Title | CHAIRMAN | Title |
| Phone | 4145773700 | Phone |
| Date Signed | 2012-04-02 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GREGORY D MLEZIVA CPA | Name |
| Phone | 7158342001 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | NICHOLAS LIESCH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53186 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 7889160 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE WELFARE BENEFITS SUCH AS LIFE INSURANCE, ACCIDENTAL DEATH AND DISMEMBERMENT, LOSS OF TIME, DISABILITY, DENTAL, VISION, HOSPITAL, AND SURGICAL BENEFITS FOR UNION MEMBERS AND THEIR SPOUSES AND/OR DEPENDENTS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6631415 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7557310 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 331534 | InvestmentIncomePriorYear |
| Investment Income Current Year | 331850 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6962949 | TotalRevenuePriorYear |
| Total Revenue Current Year | 7889160 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 7272222 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 5984780 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 460230 | OtherExpensePriorYear |
| Other Expenses Current Year | 798920 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7732452 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6783700 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -769503 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1105460 | RevenuesLessExpensesCY |
| Total Assets BOY | 9665846 | TotalAssetsBOY |
| Total Assets EOY | 10946522 | TotalAssetsEOY |
| Total Liabilities BOY | 2865200 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2770891 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6800646 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8175631 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE WELFARE BENEFITS, SUCH AS LIFE INSURANCE, ACCIDENTAL DEATH AND DISMEMBERMENT, LOSS OF TIME, DISABILITY, DENTAL, VISION, HOSPITAL, AND SURGICAL BENEFITS FOR UNION MEMBERS AND THEIR SPOUSES AND/OR DEPENDENTS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | THE WELFARE FUND IS A NON-CONTRIBUTORY PLAN COVERING ALL MEMBERS OF THE FOX VALLEY SHEET METAL LOCAL #18. THE PLAN PROVIDES WELFARE BENEFITS SUCH AS LIFE INSURANCE, ACCIDENTAL DEATH OR DISMEMBERMENT, LOSS OF TIME, DISABILITY, DENTAL, VISION, HOSPITAL, AND SURGICAL BENEFITS. | Description |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENEFIT PLAN ADMINISTRATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4145773700 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 SPRINGDALE ROAD | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53186 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (6 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| NICHOLAS LIESCH | ||||||
| CHAIRMAN/TRUSTEE | 1.00 | X | X | 0 | 0 | 0 |
| CHARLES SCHUSTER | ||||||
| SECRETARY/TRUSTEE | 1.00 | X | X | 0 | 0 | 0 |
| PATRICK LANDGRAF | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| PAUL HANSEN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| TOM FELDMANN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JEFFREY GAECKE | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RELIASTAR LIFE INSUARNCE COMPANY | |||||
| 3702 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | STOP-LOSS, LIFE, AND ACCIDENTAL DEATH | 564640 |
| BENEFIT PLAN ADMINISTRATION OF WI INC | |||||
| 11270 W PARK PLACE SUITE 950 | MILWAUKEE | WI | 53224 | THIRD PARTY ADMINISTRATOR | 224143 |
| UNITED HEALTH CARE INSURANCE COMPANY | |||||
| 10701 W RESEARCH DRIVE | MILWAUKEE | WI | 53226 | CLAIMS PROCESSING | 135415 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EMPLOYER CONTRIBUTIONS | 900099 | 6484150 | 6484150 |
| PARTICIPANT CONTRIBUTI | 900099 | 548553 | 548553 |
| SUBROGATION | 900099 | 379585 | 379585 |
| STOP-LOSS REIMBURSEMEN | 900099 | 107288 | 107288 |
| SUBSIDY REIMBURSEMENTS | 900099 | 34865 | 34865 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2869 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2869 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7557310 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 331850 | TotalRevenueColumn |
| Exclusion | $331,850 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7889160 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7557310 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $331,850 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5984780 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60724 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27484 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 358121 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5954 | Total |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal |
|---|---|
| PPO SERVICE ADMINISTRAT | 169779 |
| MISCELLANEOUS EXPENSES | 81262 |
| PAYMENTS TO LOCALS | 65470 |
| BANK FEES | 25562 |
| FICA PAID ON DISABILITY | 4564 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6783700 | Total |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1548978 | BOY |
| EOY | 2318030 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59389 | BOY |
| EOY | 67329 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7419777 | BOY |
| EOY | 7896140 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 637702 | BOY |
| EOY | 665023 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9665846 | BOY |
| EOY | 10946522 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77200 | BOY |
| EOY | 80291 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2788000 | BOY |
| EOY | 2690600 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2865200 | BOY |
| EOY | 2770891 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6800646 | BOY |
| EOY | 8175631 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6800646 | BOY |
| EOY | 8175631 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9665846 | BOY |
| EOY | 10946522 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1105460 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 269525 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| CONTRIBUTIONS RECEIVABLE | 519231 |
| STOP-LOSS RECEIVABLE | 93338 |
| OTHER RECEIVABLES | 52454 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 665023 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED LIABILITY FOR FUTURE BENEFITS | $2,335,000 |
| HEALTH CLAIMS PAYABLE AND CLAIMS IBNR | $355,600 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2690600 | TotalOfAmounts |
| Total Revenue | 7889160 | TotalRevenue |
| Total Expenses | 6783700 | TotalExpenses |
| Excess Or Deficit For Year | 1105460 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 172125 | NetUnrealizedGLOnInvestments |
| Other | $97,400 | OtherAmount |
| Total Adjustments | 269525 | TotalAdjustments |
| Excess Or Deficit Per FS | 1374985 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8061285 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 172125 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 172125 | RevenueNotRptdF990 |
| Revenue Subtotal | 7889160 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 7889160 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 6783700 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 6783700 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 6783700 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE FUND HAS ADOPTED FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE FUND WILL RECOGNIZE ANY ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED BENEFITS IN INCOME TAX, IF INCURRED. THE FUND'S PREVIOUS 3 TAX YEARS ARE OPEN FOR EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN ESTIMATED LIABILITY FOR FUTURE BENEFITS -3,000. (INCREASE) DECREASE IN IBNR 100,400. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FUND'S ATTORNEY REVIEWS FORM 990 BEFORE IT IS FILED. THE CHAIRMAN OF THE BOARD OF TRUSTEES SIGNS FORM 990 ONCE IT HAS BEEN REVIEWED BY THE ATTORNEY. | |
| THE TRUSTEES ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST IMMEDIATELY UPON DISCOVERY. EACH TRUSTEE HAS SIGNED AN AGREEMENT STATING THAT HE WILL ACT IN ACCORDANCE WITH THE TRUST AGREEMENT. | FORM 990, PART VI, SECTION B, LINE 12C | |
| DOCUMENTATION IS AVAILABLE UPON REQUEST BY CONTACTING THE FUND OR THE FUND'S ADMINISTRATOR. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC | NICHOLAS LIESCH - 2901 WELHOUSE DRIVE, KAUKAUNA, WI 54130-3541. CHARLES SCHUSTER - 51 WEST FERNAU AVENUE, OSHKOSH, WI 54901. PATRICK LANDGRAF - 2201 SPRINGDALE ROAD, WAUKESHA, WI 53186. PAUL HANSEN - 625 SAINT MARY'S STREET, DE PERE, WI 54115-1069. TOM FELDMANN - P.O. BOX 492, APPLETON, WI 54912-0492. JEFFREY GAECKE - 3315 NORTH BALLARD ROAD, SUITE D, APPLETON, WI 54911-8988. | FORM 990, PART VII |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 172,125. CHANGE IN ESTIMATED LIABILITY FOR FUTURE BENEFITS -3,000. (INCREASE) DECREASE IN IBNR 100,400. TOTAL TO FORM 990, PART XI, LINE 5: 269,525. | FORM 990, PART XI, LINE 5: |
| NO CHANGES HAVE BEEN MADE SINCE PRIOR YEAR. | FORM 990, PART XI, LINE 12C: |
Comments