Civic Intelligence

Shawano Medical Center Benefit Plan

EIN 39-1489227

309 N Bartlete Street54166
Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2010

Liabilities / Revenue

Score unavailable

No value available

Liabilities-to-revenue requires both liabilities and revenue on the latest valid filing.

Source year 2010

Net Margin

Score unavailable

No value available

Net margin requires both revenue and expenses on the latest valid filing.

Source year 2010

Top Officer Pay

Score unavailable

No value available

No filing with officer or executive compensation is available for this organization yet.

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2010

Revenue Growth

Score unavailable

No value available

No valid filing value is available for this score.

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

$0

No earlier filing loaded for comparison.

Liabilities

$0

No earlier filing loaded for comparison.

Net Assets

$0

No earlier filing loaded for comparison.

Operations
Liabilities / RevenueScore unavailableNet MarginScore unavailable

Revenue

-

No earlier filing loaded for comparison.

Expenses

$3,088,009

No earlier filing loaded for comparison.

Net Income

-

No earlier filing loaded for comparison.

Trend Graphs

Balance Sheet Trend

Asset GrowthScore unavailable

Grouped bars show assets, liabilities, and net assets across loaded filings.

$0Assets 2010: $0Liabilities 2010: $0Net Assets 2010: $02010

Highlighted filing

2010

Assets$0
Liabilities$0
Net Assets$0
Open 2010 Filing

Operations Trend

Revenue GrowthScore unavailable

Revenue, expenses, and net income by year, with the latest filing highlighted.

$4.0M$3.0M$2.0M$1.0M$0Expenses 2010: $3,088,0092010

Highlighted filing

2010

Revenue-
Expenses$3,088,009
Net Income-
Open 2010 Filing

Filings

Most recent year

2010 • Form 990Facts available. Structured filing facts are available, but richer extracted sections are limited.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
-
Expenses
$3,088,009
Net income
-
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.00$0.00$0.00$3.09
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jun 1, 2009 to Apr 30, 2010
Signed
Jan 12, 2011
Return Version
2009v1.7
Gross Receipts
$3,218,401
Filing and Contact Details

Filer

EIN
39-1489227
Raw XML Appendix365 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/ActivitiesConductedPartnership00
IRS990/ActivityOrMissionDescription0Health benefit plan trust established to provide medical and dental care benefits for employees. All activities are related to collection of premiums and payment of medical and dental care claims from providers for approximately 250 employees.
IRS990/AddressPrincipalOfficerUS/AddressLine10309 N Bartlete Street
IRS990/AddressPrincipalOfficerUS/City0Shawano
IRS990/AddressPrincipalOfficerUS/State0WI
IRS990/AddressPrincipalOfficerUS/ZIPCode054166
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IRS990/BenefitsToMembers/Total02693829
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IRS990/ContractorCompensation/AddressOfContractor/AddressUS/AddressLine1020 washington avenue southy
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IRS990/ContractorCompensation/AddressOfContractor/AddressUS/ZIPCode055401
IRS990/ContractorCompensation/Compensation0296895
IRS990/ContractorCompensation/DescriptionOfServices0Stop Loss Excess Risk
IRS990/ContractorCompensation/NameOfContractor/NameBusiness/BusinessNameLine10ReliaStar Life Insurance Company
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IRS990/DelegationOfManagementDuties00
IRS990/DescribedIn501C300
IRS990/Description0Health and welfare benefits provided for approximately 250 employees during the year.Expenses = Third party administrative fees, reinsurance premiums and claims benefits paid on behalf of employee members. Revenue = Premiums collected from employer and employees.
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IRS990/Form990PartVIISectionA/NamePerson0Larry Klement
IRS990/Form990PartVIISectionA/NamePerson1Dr Peter Keenan
IRS990/Form990PartVIISectionA/NamePerson2Paula Wegner
IRS990/Form990PartVIISectionA/NamePerson3Dick Koeppen
IRS990/Form990PartVIISectionA/NamePerson4Dr Gregrey Hiltgen
IRS990/Form990PartVIISectionA/NamePerson5Joseph Gellings
IRS990/Form990PartVIISectionA/NamePerson6Jerry Hentges
IRS990/Form990PartVIISectionA/NamePerson7Gail Moesch
IRS990/Form990PartVIISectionA/NamePerson8Russ Schmidt
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IRS990/Form990PartVIISectionA/OtherCompensation70
IRS990/Form990PartVIISectionA/OtherCompensation80
IRS990/Form990PartVIISectionA/ReportableCompFromOrganization00
IRS990/Form990PartVIISectionA/ReportableCompFromOrganization10
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IRS990/Form990PartVIISectionA/ReportableCompFromOrganization30
IRS990/Form990PartVIISectionA/ReportableCompFromOrganization40
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IRS990/Form990PartVIISectionA/ReportableCompFromRelatedOrgs70
IRS990/Form990PartVIISectionA/ReportableCompFromRelatedOrgs80
IRS990/Form990PartVIISectionA/Title0President - Board of Tru
IRS990/Form990PartVIISectionA/Title1Vice President - Board o
IRS990/Form990PartVIISectionA/Title2Treasurer - Board of Tru
IRS990/Form990PartVIISectionA/Title3Secretary - Board of Tru
IRS990/Form990PartVIISectionA/Title4Board Member
IRS990/Form990PartVIISectionA/Title5Board Member
IRS990/Form990PartVIISectionA/Title6Board Member
IRS990/Form990PartVIISectionA/Title7Board Member
IRS990/Form990PartVIISectionA/Title8Board Member
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IRS990/MethodOfAccountingAccrual0X
IRS990/MinutesOfCommittees01
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IRS990/MissionDescription0Health benefit plan trust established to provide medical and dental care benefits for employees.
IRS990/MoreThan5000KToIndividuals00
IRS990/MoreThan5000KToOrganizations00
IRS990/NameOfPrincipalOfficerPerson0Kenneth Monger
IRS990/NbrIndependentVotingMembers09
IRS990/NbrVotingGoverningBodyMembers09
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IRS990/NetAssetsOrFundBalancesBOY052473
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IRS990ScheduleD/Form990ScheduleDPartXIV/Explanation0THERE IS NO FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS - THIS IS THE FINAL RETURN OF THE ORGANIZATION.
IRS990ScheduleD/Form990ScheduleDPartXIV/Explanation1Net assets transferred out due to termination of trust: -182865.
IRS990ScheduleD/Form990ScheduleDPartXIV/Identifier0Part X:
IRS990ScheduleD/Form990ScheduleDPartXIV/Identifier1Part XI, Line 8 - Other Adjustments:
IRS990ScheduleD/Form990ScheduleDPartXIV/ReturnReference0Description of Uncertain Tax Positions Under FIN 48:
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IRS990ScheduleN/LiquidationTable/LiquidationDetail/AddressUS/AddressLine10309 North Bartlette Street
IRS990ScheduleN/LiquidationTable/LiquidationDetail/AddressUS/City0Shawano
IRS990ScheduleN/LiquidationTable/LiquidationDetail/AddressUS/State0WI
IRS990ScheduleN/LiquidationTable/LiquidationDetail/AddressUS/ZIPCode054166
IRS990ScheduleN/LiquidationTable/LiquidationDetail/DateOfDistribution02010-04-30
IRS990ScheduleN/LiquidationTable/LiquidationDetail/DescriptionOfAsset0Cash
IRS990ScheduleN/LiquidationTable/LiquidationDetail/EIN0390807068
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IRS990ScheduleN/LiquidationTable/LiquidationDetail/IRCSection0501(C)(3)
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IRS990ScheduleN/OwnerOfSuccessor00
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IRS990ScheduleO/GeneralExplanation/Explanation0CFO provides copies to all board of trustee members prior to filing with IRS and provides relevant information upon their request.
IRS990ScheduleO/GeneralExplanation/Explanation1Annual conflict of interest statements are completed and signed by each board of trustee member. Conflicts of interest disclosed by a member are reviewed by the entire board of trustees for appropriateness and resolution.
IRS990ScheduleO/GeneralExplanation/Explanation2THERE ARE NO EMPLOYEES COMPENSATED IN FOR SERVICES IN THIS ORGANIZATION.
IRS990ScheduleO/GeneralExplanation/Explanation3The organization has deemed that its govering documents, conflict of interest policy, and financial statements are the property of the organization and are not available for public inspection.
IRS990ScheduleO/GeneralExplanation/Explanation4ALL OF THE OFFICERS OF THIS ORGANIZATION ARE ALSO ON THE BOD OF SHAWANO MEDICAL CENTER, INC. AS A BOD MEMBER OF THAT ORGANIZATION, THEY AVERAGE APPROXIMATELY 2 HOURS PER WEEK OF SERVICE.
IRS990ScheduleO/GeneralExplanation/Explanation5THE PROCESS HAS NOT CHANGED FROM LAST YEAR.
IRS990ScheduleO/GeneralExplanation/Identifier0Form 990, Part VI, Section B, line 11
IRS990ScheduleO/GeneralExplanation/Identifier1Form 990, Part VI, Section B, line 12c
IRS990ScheduleO/GeneralExplanation/Identifier2Form 990, Part VI, Section B, line 15a
IRS990ScheduleO/GeneralExplanation/Identifier3Form 990, Part VI, Section C, line 19
IRS990ScheduleO/GeneralExplanation/Identifier4FORM 990, PART VII, SECTION A
IRS990ScheduleO/GeneralExplanation/Identifier5Form 990, Part XI, line 2c
IRS990ScheduleO/GeneralExplanation/ReturnReference0AVERAGE HOURS PER WEEK - RELATED ORGANIZATION
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IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode054166
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IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine10SHAWANO MEDICAL CENTER INC
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IRS990/YearFormation01984
ReasonableCauseExplanation/Explanation0The organization is filing this return late; however, we believe there is reasonable cause that should abate the late filing penalty. In addition, this is a final return for this exempt organization since it has been liquidated and all assets have been properly distributed. This organization is the health benefit plan trust for the employees of Shawano medical center. In the past, the CFO of the organization has always prepared and signed this return. In March, 2010, this CFO left our organization. The incoming CFO was unaware that his predecessor had been preparing this return internally.When our outside auditors were working on the audit for this organization, it was determined that the form 990 had not been extended. The incoming CFO immediately engaged the outside auditors to complete the form 990 after the conclusion of their audit. The organization worked diligently to quickly provide the needed information in order for the expedited completion of the form 990. Once the information was received, the outside auditors prepared the form 990 and drafts were submitted to the organization for approval which was completed expeditiously.We ask that you take the above facts into consideration, along with the taxpayer's history of timely compliance prior to this year as providing reasonable cause for the late filing of the 2009 form 990. This is a final form 990 since the trust has been liquidated and the only year in which there is an inadvertent late filing.
ReturnHeader/BuildTS02016-02-24 21:20:13Z
ReturnHeader/Filer/EIN0391489227
ReturnHeader/Filer/Name/BusinessNameLine10Shawano Medical Center Benefit Plan
ReturnHeader/Filer/NameControl0SHAW
ReturnHeader/Filer/Phone07155262111
ReturnHeader/Filer/USAddress/AddressLine10309 N Bartlete Street
ReturnHeader/Filer/USAddress/City0Shawano
ReturnHeader/Filer/USAddress/State0WI
ReturnHeader/Filer/USAddress/ZIPCode054166
ReturnHeader/Officer/AuthorizeThirdParty01
ReturnHeader/Officer/DateSigned02011-01-12
ReturnHeader/Officer/Name0KENNETH MONGER
ReturnHeader/Officer/Phone07155262111
ReturnHeader/Officer/Title0CFO
ReturnHeader/Preparer/DatePrepared02011-01-12
ReturnHeader/PreparerFirm/PreparerFirmBusinessName/BusinessNameLine10WIPFLI LLP
ReturnHeader/PreparerFirm/PreparerFirmUSAddress/AddressLine10PO BOX 12237
ReturnHeader/PreparerFirm/PreparerFirmUSAddress/City0GREEN BAY
ReturnHeader/PreparerFirm/PreparerFirmUSAddress/State0WI
ReturnHeader/PreparerFirm/PreparerFirmUSAddress/ZIPCode0543072237
ReturnHeader/Preparer/Name0Terri Rexrode CPA MST
ReturnHeader/Preparer/Phone09206620016
ReturnHeader/ReturnType0990
ReturnHeader/TaxPeriodBeginDate02009-06-01
ReturnHeader/TaxPeriodEndDate02010-04-30
ReturnHeader/TaxYear02009
ReturnHeader/Timestamp02011-01-12T06:53:05-06:00

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