Civic Intelligence

First Interstate Bancsystem Inc Health Benefits Trust

990 • Fiscal year 2016 • EIN 36-4061730

Jan 01, 2016 to Dec 31, 2016 • Filed on Nov 08, 2017

PO Box 30918Billings, MT 59116-0918

(406) 255-5300

Siviq Scores

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

Liabilities / Assets

38th percentile

0.01x

Higher debt load relative to assets than 38% of similar nonprofits.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2016

Liabilities / Revenue

20th percentile

0.00x

Higher debt load relative to revenue than 20% of similar nonprofits.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2016

Net Margin

54th percentile

4.1%

Higher net margin than 54% of similar nonprofits.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2016

Top Officer Pay

53rd percentile

$12,322

Higher top officer pay than 53% of similar nonprofits.

Top officer pay equals 0.1% of source-year revenue.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2016

Asset Growth

82nd percentile

17%

Faster asset growth than 82% of similar nonprofits.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Annualized from 2015 to 2016

Revenue Growth

51st percentile

4.1%

Faster revenue growth than 51% of similar nonprofits.

2016 filings • 501(c)9 • $25M-$50M nonprofits • Annualized from 2015 to 2016

Assets

Up

$5,807,937

Up $823,173 (+17%) from 2015

Net Assets

Up

$5,733,782

Up $860,649 (+18%) from 2015

Liabilities

Down

$74,155

Down $37,476 (-34%) from 2015

Revenue

Up

$18,502,533

Up $731,369 (+4.1%) from 2015

Expenses

Down

$17,744,032

Down $1,892,786 (-9.6%) from 2015

Net Income

Up

$758,501

Up $2,624,155 (+141%) from 2015

Historical Trend

Balance Sheet Trend

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

$8.0M$6.0M$4.0M$2.0M$0-$2.0MAssets 2010: $1,719,051Liabilities 2010: $1,977,143Net Assets 2010: -$258,0922010Assets 2011: $1,692,120Liabilities 2011: $1,281,952Net Assets 2011: $410,1682011Assets 2012: $3,978,213Liabilities 2012: $1,648,164Net Assets 2012: $2,330,0492012Assets 2013: $5,799,790Liabilities 2013: $1,313,264Net Assets 2013: $4,486,5262013Assets 2014: $7,033,369Liabilities 2014: $145,193Net Assets 2014: $6,888,1762014Assets 2015: $4,984,764Liabilities 2015: $111,631Net Assets 2015: $4,873,1332015Assets 2016: $5,807,937Liabilities 2016: $74,155Net Assets 2016: $5,733,7822016Assets 2017: $6,289,190Liabilities 2017: $23,863Net Assets 2017: $6,265,3272017Assets 2018: $4,017,924Liabilities 2018: $411,600Net Assets 2018: $3,606,3242018Assets 2019: $0Liabilities 2019: $0Net Assets 2019: $02019

Highlighted filing

2016

Assets$5,807,937
Liabilities$74,155
Net Assets$5,733,782

Operations Trend

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

$30M$20M$10M$0-$10MExpenses 2010: $14,608,7832010Expenses 2011: $16,055,1432011Expenses 2012: $14,521,5922012Revenue 2013: $17,068,062Expenses 2013: $15,296,732Net Income 2013: $1,771,3302013Revenue 2014: $16,332,497Expenses 2014: $15,208,435Net Income 2014: $1,124,0622014Revenue 2015: $17,771,164Expenses 2015: $19,636,818Net Income 2015: -$1,865,6542015Revenue 2016: $18,502,533Expenses 2016: $17,744,032Net Income 2016: $758,5012016Revenue 2017: $18,783,120Expenses 2017: $18,448,614Net Income 2017: $334,5062017Revenue 2018: $21,555,924Expenses 2018: $24,013,165Net Income 2018: -$2,457,2412018Revenue 2019: $9,229Expenses 2019: $2,851,619Net Income 2019: -$2,842,3902019

Highlighted filing

2016

Revenue$18,502,533
Expenses$17,744,032
Net Income$758,501
Jump To
Filing Snapshot
Filing Period
Jan 1, 2016 to Dec 31, 2016
Signed
Nov 8, 2017
Return Version
2016v3.0
Gross Receipts
$39,953,165
Mission and Program Overview

Mission

None.

Provide health benefits to participating employees.

Balance Sheet Detail
LineBeginningEndChange
Assets
Cap Stk Tr Prin Current Funds$4,873,133$5,733,782▲ $860,649
Investments in Publicly Traded Securities$2,103,362$5,121,569▲ $3,018,207
Savings and Temporary Cash Investments$829,424$0▼ $829,424
Accounts Receivable$1,412,972$686,368▼ $726,604
Cash and Non-Interest-Bearing Accounts$639,006$0▼ $639,006
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Rtn Earn Endowment Incm Other Fnds$0$0→ $0
Total Assets$4,984,764$5,807,937▲ $823,173
Liabilities
Accounts Payable and Accrued Expenses$111,631$74,155▼ $37,476
Total Liabilities$111,631$74,155▼ $37,476
Net Assets / Fund Balance
Total Net Assets Fund Balance$4,873,133$5,733,782▲ $860,649
Total Liabilities and Net Assets / Fund Balance$4,984,764$5,807,937▲ $823,173
Compensation and Service Providers

Employees

NameTitleBaseTotal
-Trustee$12,322$12,322

Board Members and Trustees

NameTitle
Kevin RileyCommittee Member
Larry Johns - Appointed 92015Committee Member
Maria ValandraCommittee Member
Phillip GagliaCommittee Member
Steve MaaschVP Human Resources Directo

Highest Paid Contractors

ContractorServicesLocationCompensation
Allegiance Benefit Plan Management INCAdministrative Services2806 S GARFIELD ST, Missoula, MT 59801$691,350
Western Health ScreeningHealth & Wellness Promotion339 SOUTH 26TH STREET, Billings, MT 59101$198,350
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$18,454,020
Investment Income
$48,513
Other Revenue
$0
Change in Net Assets
$758,501

Audited Revenue Reconciliation

Revenue per Audited Statements
$18,502,533
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$102,148
Total Revenue per Audited Statements
$18,604,681
Total Revenue per Form 990
$18,502,533
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$1,954,661
Salaries, Compensation, and Employee Benefits$12,322
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Benefits to Members---$15,777,049
Fees for Services Management---$807,301
Fees for Services Other---$70,287
Other Expenses---$62,977
Current Officers, Directors, Trustees, and Key Employees---$12,322
Fees for Services Accounting---$12,000
Total Functional Expenses$0$0$0$17,744,032

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$17,744,032
Total Expenses per Audited Statements$17,744,032
Total Expenses per Form 990$17,744,032
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
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 A, Line 1

First interstate bancsystem, inc's benefits committee has been delegated all management and fiduciary authority for the benefit plans of first interstate bancsystem, inc. There are 5 members of the benefits committee that oversee the health plan and they all have equal voting powers on matters.

Form 990, Part VI, Section A, Line 2

Steve maasch, ed garding, maria valandra, kevin riley, allison johnston, phillip gaglia and larry johns - business relationship.

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

A copy of the form 990 is provided to members of the benefit committee via email.

Form 990, Part VI, Section C, Line 19

The organization does not make the governing documents, conflict of interest policy or financial statements available to the public.

Form 990, Part V, Line 1A and 1C and Part VII, Column D, Individual 1

The organization compensated first interstate wealth management for services rendered as trustee. A third party, allegiance, files 1099's on behalf of first interstate bancsystem inc. Health benefits plan and trust when required.

Filing and Contact Details

Filer

Filer Name
First Interstate Bancsystem Inc Health
EIN
36-4061730
Phone
4062555300
Address
PO BOX 30918, BILLINGS, MT 59116-0918

Signing Officer

Name
Michael Cherwin
Title
Chief Human Resources Officer
Phone
4062555300
Signed
2017-11-08
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Michael Cherwin
Formed
1994
Legal Domicile
Mt
Voting Board Members
6
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Eide Bailly Llp
Address
401 N 31ST ST STE 1120 PO BOX 7112, BILLINGS, MT 59103-7112
Preparer
Maria J Christiaens
Phone
4068962400
Supplemental Narrative

Additional Explanations

Form 990, Part V, Line 3A and 3B, Filing of Form 990-T

The organization is electing to set aside investment income for the purpose of payments for health benefits to its members. The set aside election has been made by filing schedule g of form 990-t, in addition to completing a schedule in support of income set aside as attached to the 990-t.

Financial Statement Notes

PART X, LINE 2:

The trust established to hold the plan's assets is intended to qualify pursuant to section 501(c)(9) of the internal revenue code, and accordingly, the plan's net investment income is exempt from income taxes. The plan has obtained an exemption letter dated july 30, 1999 from the internal revenue service, and the employer believes that the plan, as amended, continues to qualify and to operate in accordance with the applicable requirements of the internal revenue code. Therefore, no provision for income taxes has been inclued in the plan's financial statements. Accounting principles generally accepted in the united states of america require plan management to evaluate tax positions taken by the plan and recognize a tax liability (or asset) if the plan has taken an uncertain tax position that more likely than not would not be sustained upon examination by the internal revenue service. The plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress.

Raw XML Appendix373 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.

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE TRUST ESTABLISHED TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, THE PLAN'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN HAS OBTAINED AN EXEMPTION LETTER DATED JULY 30, 1999 FROM THE INTERNAL REVENUE SERVICE, AND THE EMPLOYER BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUED IN THE PLAN'S FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalExpensesPerForm990Amt017744032
IRS990ScheduleD/TotalRevenuePerForm990Amt018502533
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt018604681
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt017744032
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0FIRST INTERSTATE BANCSYSTEM, INC'S BENEFITS COMMITTEE HAS BEEN DELEGATED ALL MANAGEMENT AND FIDUCIARY AUTHORITY FOR THE BENEFIT PLANS OF FIRST INTERSTATE BANCSYSTEM, INC. THERE ARE 5 MEMBERS OF THE BENEFITS COMMITTEE THAT OVERSEE THE HEALTH PLAN AND THEY ALL HAVE EQUAL VOTING POWERS ON MATTERS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1STEVE MAASCH, ED GARDING, MARIA VALANDRA, KEVIN RILEY, ALLISON JOHNSTON, PHILLIP GAGLIA AND LARRY JOHNS - BUSINESS RELATIONSHIP.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2A COPY OF THE FORM 990 IS PROVIDED TO MEMBERS OF THE BENEFIT COMMITTEE VIA EMAIL.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE ORGANIZATION COMPENSATED FIRST INTERSTATE WEALTH MANAGEMENT FOR SERVICES RENDERED AS TRUSTEE. A THIRD PARTY, ALLEGIANCE, FILES 1099'S ON BEHALF OF FIRST INTERSTATE BANCSYSTEM INC. HEALTH BENEFITS PLAN AND TRUST WHEN REQUIRED.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE ORGANIZATION IS ELECTING TO SET ASIDE INVESTMENT INCOME FOR THE PURPOSE OF PAYMENTS FOR HEALTH BENEFITS TO ITS MEMBERS. THE SET ASIDE ELECTION HAS BEEN MADE BY FILING SCHEDULE G OF FORM 990-T, IN ADDITION TO COMPLETING A SCHEDULE IN SUPPORT OF INCOME SET ASIDE AS ATTACHED TO THE 990-T.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 1
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART V, LINE 1A AND 1C AND PART VII, COLUMN D, INDIVIDUAL 1
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART V, LINE 3A AND 3B, FILING OF FORM 990-T
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN0810331430
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt0C
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0MT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0BANK
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0FIRST INTERSTATE BANCSYSTEM INC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt0PO BOX 30918
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm0BILLINGS
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0MT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd059116
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd00
IRS990ScheduleR/PerformOfServicesByOtherOrgInd01
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd00
IRS990ScheduleR/TransferFromOtherOrgInd00
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt04984764
IRS990/TotalAssetsEOYAmt05807937
IRS990/TotalAssetsGrp/BOYAmt04984764
IRS990/TotalAssetsGrp/EOYAmt05807937
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/TotalAmt017744032
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt0111631
IRS990/TotalLiabilitiesEOYAmt074155
IRS990/TotalLiabilitiesGrp/BOYAmt0111631
IRS990/TotalLiabilitiesGrp/EOYAmt074155
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt04873133
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt05733782
IRS990/TotalOtherCompensationAmt00
IRS990/TotalProgramServiceRevenueAmt018454020
IRS990/TotalReportableCompFromOrgAmt012322
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt018502533
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt018502533
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt04984764
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt05807937
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TypeOfOrganizationTrustInd0X
IRS990/UnrelatedBusIncmOverLimitInd01
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt0401 N 31ST STREET
IRS990/USAddress/CityNm0BILLINGS
IRS990/USAddress/StateAbbreviationCd0MT
IRS990/USAddress/ZIPCd059101
IRS990/VotingMembersGoverningBodyCnt06
IRS990/VotingMembersIndependentCnt00
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02017-02-10 21:41:12Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0MICHAEL CHERWIN
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0CHIEF HUMAN RESOURCES OFFICER
ReturnHeader/BusinessOfficerGrp/PhoneNum04062555300
ReturnHeader/BusinessOfficerGrp/SignatureDt02017-11-08
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0FIRST INTERSTATE BANCSYSTEM INC HEALTH
ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt0BENEFITS TRUST
ReturnHeader/Filer/BusinessNameControlTxt0FIRS
ReturnHeader/Filer/EIN0364061730
ReturnHeader/Filer/PhoneNum04062555300
ReturnHeader/Filer/USAddress/AddressLine1Txt0PO BOX 30918
ReturnHeader/Filer/USAddress/CityNm0BILLINGS
ReturnHeader/Filer/USAddress/StateAbbreviationCd0MT
ReturnHeader/Filer/USAddress/ZIPCd0591160918
ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0773F594F1DF8224FB2F5BD22B7082FEE9BE4371F
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId01F49503CC3E022741DED67EBE73B8B991417DC74
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0154.45.214.19
ReturnHeader/FilingSecurityInformation/IPDt02017-11-08
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0MS
ReturnHeader/FilingSecurityInformation/IPTm015:32:47
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0450250958
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0EIDE BAILLY LLP
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0401 N 31ST ST STE 1120 PO BOX 7112
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0BILLINGS
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0MT
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd0591037112
ReturnHeader/PreparerPersonGrp/PhoneNum04068962400
ReturnHeader/PreparerPersonGrp/PreparationDt02017-11-08
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0MARIA J CHRISTIAENS
ReturnHeader/ReturnTs02017-11-08T16:35:20-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02016-01-01
ReturnHeader/TaxPeriodEndDt02016-12-31
ReturnHeader/TaxYr02016

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