Civic Intelligence

Provider Services Benefits Trust

990 • Fiscal year 2017 • EIN 26-6672281

Jan 01, 2017 to Dec 31, 2017 • Filed on Nov 07, 2018

Organization ProfileN/A
25000 Country Club Blvd No 255North Olmsted, OH 44070

(440) 793-2247

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on this filing.

Source year 2017

Liabilities / Revenue

67th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2017 filings • 501(c)9 • <$500k nonprofits • Source year 2017

Net Margin

2nd percentile

-38316%

Higher net margin than 2% of similar nonprofits.

2017 filings • 501(c)9 • <$500k nonprofits • Source year 2017

Top Officer Pay

72nd percentile

$0

Higher top officer pay than 72% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

2017 filings • 501(c)9 • <$500k nonprofits • Source year 2017

Asset Growth

10th percentile

-100%

Faster asset growth than 10% of similar nonprofits.

2017 filings • 501(c)9 • <$500k nonprofits • Annualized from 2016 to 2017

Revenue Growth

99th percentile

13789%

Faster revenue growth than 99% of similar nonprofits.

2017 filings • 501(c)9 • <$500k nonprofits • Annualized from 2016 to 2017

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

Down

$0

Down $2,013,658 (-100%) from 2016

Net Assets

Down

$0

Down $1,969,043 (-100%) from 2016

Liabilities

Down

$0

Down $44,615 (-100%) from 2016

Revenue And Expenses
Liabilities / Revenue67th percentileNet Margin2nd percentile

Revenue

Up

$5,139

Up $5,102 (+13789%) from 2016

Expenses

Up

$1,974,182

Up $1,727,124 (+699%) from 2016

Net Income

Down

-$1,969,043

Down $1,722,022 (-697%) from 2016

Historical Trend

Balance Sheet Trend

Asset Growth10th percentile

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$15M$10M$5.0M$0Assets 2010: $3,000,676Liabilities 2010: $0Net Assets 2010: $3,000,6762010Assets 2011: $6,250,395Liabilities 2011: $0Net Assets 2011: $6,250,3952011Assets 2012: $13,407,187Liabilities 2012: $0Net Assets 2012: $13,407,1872012Assets 2013: $4,010,615Liabilities 2013: $0Net Assets 2013: $4,010,6152013Assets 2014: $13,801Liabilities 2014: $0Net Assets 2014: $13,8012014Assets 2015: $3,137,743Liabilities 2015: $921,679Net Assets 2015: $2,216,0642015Assets 2016: $2,013,658Liabilities 2016: $44,615Net Assets 2016: $1,969,0432016Assets 2017: $0Liabilities 2017: $0Net Assets 2017: $02017

Highlighted filing

2017

Assets$0
Liabilities$0
Net Assets$0
Open 2017 Filing

Operations Trend

Revenue Growth99th percentile

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$30M$20M$10M$0-$10MExpenses 2010: $15,987,1422010Expenses 2011: $17,854,5322011Expenses 2012: $26,421,5992012Revenue 2013: $19,710,275Expenses 2013: $28,885,298Net Income 2013: -$9,175,0232013Revenue 2014: $17,699,952Expenses 2014: $21,696,766Net Income 2014: -$3,996,8142014Revenue 2015: $3,130,942Expenses 2015: $928,679Net Income 2015: $2,202,2632015Revenue 2016: $37Expenses 2016: $247,058Net Income 2016: -$247,0212016Revenue 2017: $5,139Expenses 2017: $1,974,182Net Income 2017: -$1,969,0432017

Highlighted filing

2017

Revenue$5,139
Expenses$1,974,182
Net Income-$1,969,043
Open 2017 Filing
Jump To
Filing Snapshot
Filing Period
Jan 1, 2017 to Dec 31, 2017
Signed
Nov 7, 2018
Return Version
2017v2.3
Gross Receipts
$5,139
Mission and Program Overview

Mission

To fund health care and workers' compensation benefits to the eligible employees of the provider services companies.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$2,013,656$0▼ $2,013,656
Rtn Earn Endowment Incm Other Fnds$1,969,043$0▼ $1,969,043
Cash and Non-Interest-Bearing Accounts$2$0▼ $2
Accounts Receivable-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Investments in Publicly Traded Securities-$0-
Land, Buildings, and Equipment, Net-$0-
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$2,013,658$0▼ $2,013,658
Other Assets Total-$0-
Liabilities
Other Liabilities$44,615$0▼ $44,615
Total Liabilities$44,615$0▼ $44,615
Net Assets / Fund Balance
Total Net Assets Fund Balance$1,969,043$0▼ $1,969,043
Total Liabilities and Net Assets / Fund Balance$2,013,658$0▼ $2,013,658
Compensation and Service Providers
Top Officer Pay72nd percentile

Board Members and Trustees

NameTitle
-Trustee
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$5,139
Other Revenue
$0
Change in Net Assets
$-1,969,043

Audited Revenue Reconciliation

Revenue per Audited Statements
$5,139
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$5,139
Total Revenue per Form 990
$5,139
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$5,667
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Benefits to Members---$1,968,515
Fees for Services Management---$5,667
Total Functional Expenses$0$0$0$1,974,182

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$1,974,182
Total Expenses per Audited Statements$1,974,182
Total Expenses per Form 990$1,974,182
Expenses Not Reported on Financial Statements$0
Expenses Not Reported on Form 990$0
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Audit committee
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
No
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section B, Line 11B

“All members of the governing body review and approve the 990 before it is filed.”

Form 990, Part VI, Section C, Line 19

“The 990 is available upon request.”

Filing and Contact Details

Filer

Filer Name
Provider Services Benefits Trust
EIN
26-6672281
Phone
4407932247
Address
25000 COUNTRY CLUB BLVD NO 255, NORTH OLMSTED, OH 44070

Signing Officer

Name
John Krystowski
Title
Officer
Phone
4407932247
Signed
2018-11-07
Discuss with paid preparer
Yes

Organization Details

Principal Officer
John Krystowski
Formed
2008
Legal Domicile
Oh
Voting Board Members
1
Independent Board Members
1
Employees
0
Volunteers
0

Preparer

Firm
Corrigan Krause
Address
2055 CROCKER RD SUITE 300, WESTLAKE, OH 44145-1964
Preparer
Sheri L Terens CPA
Phone
4404710800
Raw XML Appendix300 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

Path#Value
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IRS990/AccountsReceivableGrp/EOYAmt00
IRS990/ActivitiesConductedPrtshpInd00
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IRS990/AuditCommitteeInd00
IRS990/BenefitsToMembersGrp/TotalAmt01968515
IRS990/BooksInCareOfDetail/BusinessName/BusinessNameLine1Txt0JOHN KRYSTOWSKI
IRS990/BooksInCareOfDetail/PhoneNum04407932247
IRS990/BooksInCareOfDetail/USAddress/AddressLine1Txt025000 COUNTRY CLUB BLVD 255
IRS990/BooksInCareOfDetail/USAddress/CityNm0NORTH OLMSTED
IRS990/BooksInCareOfDetail/USAddress/StateAbbreviationCd0OH
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IRS990/DescribedInSection501c3Ind00
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IRS990/FinalReturnInd0X
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IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt00.00
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IRS990/Form990PartVIISectionAGrp/InstitutionalTrusteeInd0X
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt00
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IRS990/Form990PartVIISectionAGrp/TitleTxt0TRUSTEE
IRS990/Form990ProvidedToGvrnBodyInd01
IRS990/FormationYr02008
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IRS990/GrantsToIndividualsInd00
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IRS990/GrantToRelatedPersonInd00
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IRS990/GroupReturnForAffiliatesInd00
IRS990/IncludeFIN48FootnoteInd00
IRS990/IndependentAuditFinclStmtInd01
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IRS990/IndivRcvdGreaterThan100KCnt00
IRS990/IndoorTanningServicesInd00
IRS990/InfoInScheduleOPartVIInd0X
IRS990/IntangibleAssetsGrp/EOYAmt00
IRS990/InventoriesForSaleOrUseGrp/EOYAmt00
IRS990/InvestmentIncomeGrp/RelatedOrExemptFuncIncomeAmt05139
IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt05139
IRS990/InvestmentInJointVentureInd00
IRS990/InvestmentsOtherSecuritiesGrp/EOYAmt00
IRS990/InvestmentsProgramRelatedGrp/EOYAmt00
IRS990/InvestmentsPubTradedSecGrp/EOYAmt00
IRS990/IRPDocumentCnt00
IRS990/IRPDocumentW2GCnt00
IRS990/LandBldgEquipBasisNetGrp/EOYAmt00
IRS990/LegalDomicileStateCd0OH
IRS990/LoanOutstandingInd00
IRS990/LocalChaptersInd00
IRS990/MaterialDiversionOrMisuseInd00
IRS990/MembersOrStockholdersInd00
IRS990/MethodOfAccountingCashInd0X
IRS990/MinutesOfCommitteesInd01
IRS990/MinutesOfGoverningBodyInd01
IRS990/MissionDesc0TO FUND HEALTH CARE AND WORKERS' COMPENSATION BENEFITS TO THE ELIGIBLE EMPLOYEES OF THE PROVIDER SERVICES COMPANIES.
IRS990/MoreThan5000KToIndividualsInd00
IRS990/MoreThan5000KToOrgInd00
IRS990/NetAssetsOrFundBalancesBOYAmt01969043
IRS990/NetAssetsOrFundBalancesEOYAmt00
IRS990/NetUnrelatedBusTxblIncmAmt00
IRS990/NoListedPersonsCompensatedInd0X
IRS990/NondeductibleContributionsInd00
IRS990/OfficerMailingAddressInd00
IRS990/OperateHospitalInd00
IRS990/Organization501cInd0X
IRS990/OrgDoesNotFollowSFAS117Ind0X
IRS990/OtherAssetsTotalGrp/EOYAmt00
IRS990/OtherChangesInNetAssetsAmt00
IRS990/OtherLiabilitiesGrp/BOYAmt044615
IRS990/OtherLiabilitiesGrp/EOYAmt00
IRS990/OthNotesLoansReceivableNetGrp/EOYAmt00
IRS990/PartialLiquidationInd00
IRS990/PdInCapSrplsLandBldgEqpFundGrp/BOYAmt00
IRS990/PdInCapSrplsLandBldgEqpFundGrp/EOYAmt00
IRS990/PledgesAndGrantsReceivableGrp/EOYAmt00
IRS990/PoliticalCampaignActyInd00
IRS990/PrepaidExpensesDefrdChargesGrp/EOYAmt00
IRS990/PrincipalOfficerNm0JOHN KRYSTOWSKI
IRS990/ProfessionalFundraisingInd00
IRS990/ProhibitedTaxShelterTransInd00
IRS990/PYBenefitsPaidToMembersAmt0239988
IRS990/PYContributionsGrantsAmt00
IRS990/PYGrantsAndSimilarPaidAmt00
IRS990/PYInvestmentIncomeAmt037
IRS990/PYOtherExpensesAmt07070
IRS990/PYOtherRevenueAmt00
IRS990/PYProgramServiceRevenueAmt00
IRS990/PYRevenuesLessExpensesAmt0-247021
IRS990/PYSalariesCompEmpBnftPaidAmt00
IRS990/PYTotalExpensesAmt0247058
IRS990/PYTotalProfFndrsngExpnsAmt00
IRS990/PYTotalRevenueAmt037
IRS990/QuidProQuoContributionsInd00
IRS990/RcvblFromDisqualifiedPrsnGrp/EOYAmt00
IRS990/ReceivablesFromOfficersEtcGrp/EOYAmt00
IRS990/ReconcilationRevenueExpnssAmt0-1969043
IRS990/RelatedEntityInd01
IRS990/RelatedOrganizationCtrlEntInd00
IRS990/ReportInvestmentsOtherSecInd00
IRS990/ReportLandBuildingEquipmentInd00
IRS990/ReportOtherAssetsInd00
IRS990/ReportOtherLiabilitiesInd00
IRS990/ReportProgramRelatedInvstInd00
IRS990/RevenueAmt05139
IRS990/RtnEarnEndowmentIncmOthFndsGrp/BOYAmt01969043
IRS990/RtnEarnEndowmentIncmOthFndsGrp/EOYAmt00
IRS990/SavingsAndTempCashInvstGrp/BOYAmt02013656
IRS990/SavingsAndTempCashInvstGrp/EOYAmt00
IRS990/ScheduleBRequiredInd00
IRS990ScheduleD/ExpensesNotReportedAmt00
IRS990ScheduleD/ExpensesNotRptFinclStmtAmt00
IRS990ScheduleD/ExpensesSubtotalAmt01974182
IRS990ScheduleD/RevenueNotReportedAmt00
IRS990ScheduleD/RevenueNotReportedFinclStmtAmt00
IRS990ScheduleD/RevenueSubtotalAmt05139
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalExpensesPerForm990Amt01974182
IRS990ScheduleD/TotalRevenuePerForm990Amt05139
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt05139
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt01974182
IRS990/ScheduleJRequiredInd00
IRS990ScheduleN/AssetsDistributedInd00
IRS990ScheduleN/AttorneyGeneralNotifiedInd00
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd00
IRS990ScheduleN/EmployeeOfSuccessorInd00
IRS990ScheduleN/LiabilitiesPaidInd00
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0ORGANIZATION DISTRIBUTED ALL OF ITS ASSETS DURING THE YEAR
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd00
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE 990 IS AVAILABLE UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION B, LINE 11B
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IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd00
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IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd01
IRS990ScheduleR/PerformOfServicesByOtherOrgInd00
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
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IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd01
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IRS990/SchoolOperatingInd00
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IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
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IRS990/TotalAssetsEOYAmt00
IRS990/TotalAssetsGrp/BOYAmt02013658
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IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalEmployeeCnt00
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IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt044615
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IRS990/VotingMembersGoverningBodyCnt01
IRS990/VotingMembersIndependentCnt01
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02019-02-21 02:37:17Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0JOHN KRYSTOWSKI
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0OFFICER
ReturnHeader/BusinessOfficerGrp/PhoneNum04407932247
ReturnHeader/BusinessOfficerGrp/SignatureDt02018-11-07
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0PROVIDER SERVICES BENEFITS TRUST
ReturnHeader/Filer/BusinessNameControlTxt0PROV
ReturnHeader/Filer/EIN0266672281
ReturnHeader/Filer/PhoneNum04407932247
ReturnHeader/Filer/USAddress/AddressLine1Txt025000 COUNTRY CLUB BLVD NO 255
ReturnHeader/Filer/USAddress/CityNm0NORTH OLMSTED
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ReturnHeader/Filer/USAddress/ZIPCd044070
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ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0207.58.222.162
ReturnHeader/FilingSecurityInformation/IPDt02018-11-07
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0ES
ReturnHeader/FilingSecurityInformation/IPTm010:19:15
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0371574855
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0CORRIGAN KRAUSE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt02055 CROCKER RD SUITE 300
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0WESTLAKE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0OH
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd0441451964
ReturnHeader/PreparerPersonGrp/PhoneNum04404710800
ReturnHeader/PreparerPersonGrp/PreparationDt02018-11-07
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0SHERI L TERENS CPA
ReturnHeader/ReturnTs02018-11-15T12:11:58-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02017-01-01
ReturnHeader/TaxPeriodEndDt02017-12-31
ReturnHeader/TaxYr02017

Document Assets

No mirrored PDF or thumbnail assets are attached yet.

Filings

Displayed year

2017 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
$5,139
Expenses
$1,974,182
Net income
-$1,969,043
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2017Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$0.01$1.97$1.97
2016XML pending. An XML filing is linked for this year, but detailed extraction is still pending.$2.01$0.04$1.97$0.00$0.25$0.25
2015Detailed filing. Detailed filing data is available for this year.$3.14$0.92$2.22$3.13$0.93$2.20
2014Detailed filing. Detailed filing data is available for this year.$0.01$0.00$0.01$17.7$21.7$4.00
2013Detailed filing. Detailed filing data is available for this year.$4.01$0.00$4.01$19.7$28.9$9.18
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$13.4$0.00$13.4$26.4
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$6.25$0.00$6.25$17.9
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$3.00$0.00$3.00$16.0