2012-11-09T09:59:45-06:00 2011-12-31 990 2011-01-01 363831874 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN MOSA 4028963884 4980 SOUTH 118TH STREET NO A OMAHA NE 68137 CYNTHIA L SCHROEDER 4028963884 2012-10-30 2011 2016-02-24 21:20:13Z CYNTHIA L SCHROEDER 4980 SOUTH 118TH STREET NO A OMAHA NE 68137 26816992 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 0 0 0 0 17963341 19674479 177948 189099 71 0 18141360 19863578 0 0 13336433 16677946 0 0 0 0 0 2644069 2263012 15980502 18940958 2160858 922620 14567313 15679707 2283149 2398802 12284164 13280905 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 18588939 19672390 COMPREHENSIVE MEDICAL AND DENTAL CARE, EMPLOYEE ASSISTANCE WITH MENTAL AND NERVOUS DISORDERS AND EDUCATION COMPENSATION BENEFITS FOR ELIGIBLE EMPLOYEES AND DEPENDENTS. THERE WERE 2,944 ELIGIBLE EMPLOYEES, OF WHICH 2,644 WERE PARTICIPATING IN THE PLAN DURING THIS FISCAL YEAR. 18588939 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 0 1 0 0 1 0 1 1 0 0 0 0 0 X 3 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CYNTHIA SCHROEDER 4028963884 4980 S 118TH ST SUITE A OMAHA NE 68137 GREAT WESTERN BANK 0.10 X 0 0 0 LINDA TIMMONS 0.10 X 0 362049 14496 CYNTHIA SCHROEDER 0.10 X 0 283398 14496 0 645447 28992 0 0 1 0 0 EMPLOYER CONTRIBUTIONS 525100 16264320 16264320 EMPLOYEES CONTRIBUTION 525100 3410159 3410159 19674479 190638 190638 6951875 6953414 -1539 -1539 -1539 19863578 19672940 0 190638 16677946 16677946 1415592 1115592 300000 4550 4550 68368 68368 47469 47469 STOP LOSS PREMIUMS 342765 342765 LIFE INSURANCE PREMIUMS 138263 138263 WELLNESS 119856 119856 BOND PREMIUMS 103270 103270 22879 22879 18940958 18588939 352019 0 3495076 2620189 2089993 1765513 1229383 1537082 7752861 9756923 14567313 15679707 2283149 2398802 2283149 2398802 X 0 0 0 0 12284164 13280905 12284164 13280905 14567313 15679707 X 922620 74122 X 0 0 0 0 FIXED INCOME SECURITIES 9756923 F 9756923 19863578 18940958 922620 74122 74122 996742 X 1 1 X X X X 0 0 0 LINDA TIMMONS 0 362049 0 0 0 0 0 0 0 14496 0 376545 0 0 CYNTHIA SCHROEDER 0 283398 0 0 0 0 0 0 0 14496 0 297894 0 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 74,122. 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 1 MOSAIC R 19665529 PREMIUM PAYMENTS