Civic Intelligence

Unknown Organization

990 • Fiscal year 2013 • EIN 42-1320408

Jan 01, 2013 to Dec 31, 2013 • Filed on Nov 14, 2014

Organization ProfileN/A

View Organization Page

1600 Diamond St51040-1548

(712) 423-2311

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 2013

Liabilities / Revenue

39th percentile

0.00x

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

2013 filings • 501(c)9 • $1M-$5M nonprofits • Source year 2013

Net Margin

9th percentile

-46%

Higher net margin than 9% of similar nonprofits.

2013 filings • 501(c)9 • $1M-$5M nonprofits • Source year 2013

Top Officer Pay

84th percentile

$171,711

Higher top officer pay than 84% of similar nonprofits.

Top officer pay equals 14.8% of source-year revenue.

2013 filings • 501(c)9 • $1M-$5M nonprofits • Source year 2013

Asset Growth

1st percentile

-100%

Faster asset growth than 1% of similar nonprofits.

2013 filings • 501(c)9 • $1M-$5M nonprofits • Annualized from 2012 to 2013

Revenue Growth

Score unavailable

No value available

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

Source year 2013

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

Down

$0

Down $724,287 (-100%) from 2012

Net Assets

Down

$0

Down $534,338 (-100%) from 2012

Liabilities

Down

$0

Down $189,949 (-100%) from 2012

Revenue And Expenses
Liabilities / Revenue39th percentileNet Margin9th percentile

Revenue

$1,158,287

No earlier filing loaded for comparison.

Expenses

Up

$1,692,625

Up $200,158 (+13%) from 2012

Net Income

-$534,338

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

Asset Growth1st percentile

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

$800K$600K$400K$200K$0Assets 2010: $350,279Liabilities 2010: $185,676Net Assets 2010: $164,6032010Assets 2011: $569,543Liabilities 2011: $157,849Net Assets 2011: $411,6942011Assets 2012: $724,287Liabilities 2012: $189,949Net Assets 2012: $534,3382012Assets 2013: $0Liabilities 2013: $0Net Assets 2013: $02013

Highlighted filing

2013

Assets$0
Liabilities$0
Net Assets$0
Open 2013 Filing

Operations Trend

Revenue GrowthScore unavailable

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

$2.0M$1.0M$0-$1.0MExpenses 2010: $1,515,2282010Expenses 2011: $1,357,4242011Expenses 2012: $1,492,4672012Revenue 2013: $1,158,287Expenses 2013: $1,692,625Net Income 2013: -$534,3382013

Highlighted filing

2013

Revenue$1,158,287
Expenses$1,692,625
Net Income-$534,338
Open 2013 Filing
Jump To
Filing Snapshot
Filing Period
Jan 1, 2013 to Dec 31, 2013
Signed
Nov 14, 2014
Return Version
2013v3.0
Gross Receipts
$1,158,287
Mission and Program Overview

Mission

To pay medical claims for participants

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$696,127$0▼ $696,127
Accounts Receivable$2,280$0▼ $2,280
Cash and Non-Interest-Bearing Accounts-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable$0$0→ $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-
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$724,287$0▼ $724,287
Other Assets Total$25,880$0▼ $25,880
Liabilities
Accounts Payable and Accrued Expenses$189,949--
Total Liabilities$189,949$0▼ $189,949
Net Assets / Fund Balance
Temporarily Rstr Net Assets$534,338$0▼ $534,338
Total Net Assets Fund Balance$534,338$0▼ $534,338
Total Liabilities and Net Assets / Fund Balance$724,287$0▼ $724,287
Compensation and Service Providers
Top Officer Pay84th percentile

Board Members and Trustees

NameTitle
Keith SchrunkTrustee
Marvin MalyTrustee
Terry FramkeTrustee
Francis TrampCEO
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$1,158,154
Investment Income
$133
Other Revenue
$0
Change in Net Assets
$-534,338

Audited Revenue Reconciliation

Revenue per Audited Statements
$1,158,287
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$1,158,287
Total Revenue per Form 990
$1,158,287
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$278,521
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$1,414,104--$1,414,104
Other Expenses$174,247$92,074-$92,074
Fees for Services Accounting-$12,200-$12,200
Total Functional Expenses$1,588,351$104,274$0$1,692,625

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$1,692,625
Total Expenses per Audited Statements$1,692,625
Total Expenses per Form 990$1,692,625
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
Yes
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 8B

“There are no other committees with authority to act on behalf of the governing body, and as such there would be no contemporaneous documentation of those meetings.”

Form 990, Part VI, Section B, Line 11

“The form 990 is reviewed and approved by the ceo and cfo of burgess health center before the form 990 is filed. A copy is provided to all board members before filing.”

Form 990, Part VI, Section B, Line 15

“Burgess health corp employee benefit trust does not pay compensation to a ceo, executive director, top management official, officers, or employees. Therefore, there is not a process in place for determining compensation.”

Form 990, Part VI, Section C, Line 19

“The trust makes its governing documents and financial statements available to the public upon request.”

FORM 990, PART VI, SECTION B, LINES 12A, 12B & 12C:

“The governing body uses the conflict of interest policy of the burgess health center. The trustees are required to disclose annually interests that could rise to conflicts.”

FORM 990, PART VI, SECTION B, LINE 13:

“The trust does not have a written whistleblower policy, but it does use the policy of the burgess health center.”

Form 990, Part VI, Section B, Line 14.

“The trust does not have a written document retention and destruction policy, but it does use the policy of the burgess health center.”

Filing and Contact Details

Filer

EIN
42-1320408
Phone
7124232311

Signing Officer

Name
Nancy Carlson
Title
CFO
Phone
7124232311
Signed
2014-11-14
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Nancy Carlson
Formed
1988
Legal Domicile
Ia
Voting Board Members
3
Independent Board Members
3
Employees
0
Volunteers
0

Preparer

Preparer
Barbara J Fajen
Phone
4023302660
Supplemental Narrative

Additional Explanations

FORM 990, PART XII, LINE 2C:

“Burgess health center board of directors assumes responsibility for the audit and selection of an independent accountant. This process has not changed from the prior year.”

Financial Statement Notes

PART X, LINE 2:

“The veba trust established under the plan to hold the plan's assets is qualified pursuant to section 501(c)(9) of the internal revenue code, and accordingly, the veba trust's contributions and income, net of expenses, are exempt from income taxes. The veba trust has obtained a favorable tax determination letter from the internal revenue service dated january 5, 1989, and the plan administrator believes that the veba trust, as amended, continues to qualify and to operate in compliance with the applicable requirements of the internal revenue code. The veba trust was terminated effective december 31,2013. 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 organization has taken an uncertain tax position that more likely than not would not be sustained upon examination by the internal revenue service. The plan administrator has analyzed the tax positions taken by the plan, and has concluded that as of december 31, 2013, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or asset or disclosure in the financial statements. The plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in process. With few exceptions, the plan administrator believes it is no longer subject to income tax examinations by tax authorities for years prior to 2010.”

Raw XML Appendix383 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
IRS990/AccountantCompileOrReviewInd00
IRS990/AccountsPayableAccrExpnssGrp/BOYAmt0189949
IRS990/AccountsReceivableGrp/BOYAmt02280
IRS990/AccountsReceivableGrp/EOYAmt00
IRS990/ActivitiesConductedPrtshpInd00
IRS990/ActivityOrMissionDesc0TO PAY MEDICAL CLAIMS FOR PARTICIPANTS
IRS990/AuditCommitteeInd01
IRS990/BenefitsToMembersGrp/ProgramServicesAmt01414104
IRS990/BenefitsToMembersGrp/TotalAmt01414104
IRS990/BooksInCareOfDetail/BusinessName/BusinessNameLine10NANCY CARLSON
IRS990/BooksInCareOfDetail/PhoneNum07124232311
IRS990/BooksInCareOfDetail/USAddress/AddressLine101600 DIAMOND ST
IRS990/BooksInCareOfDetail/USAddress/City0ONAWA
IRS990/BooksInCareOfDetail/USAddress/State0IA
IRS990/BooksInCareOfDetail/USAddress/ZIPCode0510401548
IRS990/BusinessRlnWithFamMemInd00
IRS990/BusinessRlnWithOfficerEntInd00
IRS990/BusinessRlnWithOrgMemInd00
IRS990/CashNonInterestBearingGrp/EOYAmt00
IRS990/ChangeToOrgDocumentsInd00
IRS990/CntrctRcvdGreaterThan100KCnt00
IRS990/CollectionsOfArtInd00
IRS990/CompensationFromOtherSrcsInd00
IRS990/CompensationProcessCEOInd00
IRS990/CompensationProcessOtherInd00
IRS990/ConflictOfInterestPolicyInd00
IRS990/ConservationEasementsInd00
IRS990/ConsolidatedAuditFinclStmtInd00
IRS990/CreditCounselingInd00
IRS990/CYBenefitsPaidToMembersAmt01414104
IRS990/CYContributionsGrantsAmt00
IRS990/CYGrantsAndSimilarPaidAmt00
IRS990/CYInvestmentIncomeAmt0133
IRS990/CYOtherExpensesAmt0278521
IRS990/CYOtherRevenueAmt00
IRS990/CYProgramServiceRevenueAmt01158154
IRS990/CYRevenuesLessExpensesAmt0-534338
IRS990/CYSalariesCompEmpBnftPaidAmt00
IRS990/CYTotalExpensesAmt01692625
IRS990/CYTotalFundraisingExpenseAmt00
IRS990/CYTotalProfFndrsngExpnsAmt00
IRS990/CYTotalRevenueAmt01158287
IRS990/DecisionsSubjectToApprovaInd00
IRS990/DeductibleArtContributionInd00
IRS990/DeductibleNonCashContriInd00
IRS990/DelegationOfMgmtDutiesInd00
IRS990/Desc0EMPLOYEE HEALTH AND DENTAL PLAN - HOSPITALIZATION, MEDICAL, MAJOR MEDICAL, SURGICAL AND DENTAL
IRS990/DescribedInSection501c3Ind00
IRS990/DisregardedEntityInd00
IRS990/DocumentRetentionPolicyInd00
IRS990/DonorAdvisedFundInd00
IRS990/ElectionOfBoardMembersInd00
IRS990/EmployeeCnt00
IRS990/ExpenseAmt01588351
IRS990/FamilyOrBusinessRlnInd00
IRS990/FederalGrantAuditRequiredInd00
IRS990/FeesForServicesAccountingGrp/ManagementAndGeneralAmt012200
IRS990/FeesForServicesAccountingGrp/TotalAmt012200
IRS990/FinalReturnInd0X
IRS990/ForeignActivitiesInd00
IRS990/ForeignFinancialAccountInd00
IRS990/ForeignOfficeInd00
IRS990/Form8282PropertyDisposedOfInd00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt00.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt10.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt20.00
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt339.70
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt00.30
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt10.30
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt20.30
IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt30.30
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd0X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd1X
IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd2X
IRS990/Form990PartVIISectionAGrp/OfficerInd0X
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt00
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt10
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt20
IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt315474
IRS990/Form990PartVIISectionAGrp/PersonNm0TERRY FRAMKE
IRS990/Form990PartVIISectionAGrp/PersonNm1MARVIN MALY
IRS990/Form990PartVIISectionAGrp/PersonNm2KEITH SCHRUNK
IRS990/Form990PartVIISectionAGrp/PersonNm3FRANCIS TRAMP
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt10
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt20
IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt30
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt00
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt10
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt20
IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt3156237
IRS990/Form990PartVIISectionAGrp/TitleTxt0TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt1TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt2TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt3CEO
IRS990/Form990ProvidedToGvrnBodyInd01
IRS990/FormationYr01988
IRS990/FormerOfcrEmployeesListedInd00
IRS990/FSAuditedBasisGrp/SeparateBasisFinclStmtInd0X
IRS990/FSAuditedInd01
IRS990/FundraisingActivitiesInd00
IRS990/GamingActivitiesInd00
IRS990/GoverningBodyVotingMembersCnt03
IRS990/GrantsToIndividualsInd00
IRS990/GrantsToOrganizationsInd00
IRS990/GrantToRelatedPersonInd00
IRS990/GrossReceiptsAmt01158287
IRS990/GroupReturnForAffiliatesInd00
IRS990/IncludeFIN48FootnoteInd01
IRS990/IndependentAuditFinclStmtInd01
IRS990/IndependentVotingMemberCnt03
IRS990/IndivRcvdGreaterThan100KCnt00
IRS990/IndoorTanningServicesInd00
IRS990/InfoInScheduleOPartVIInd0X
IRS990/InfoInScheduleOPartXIIInd0X
IRS990/IntangibleAssetsGrp/EOYAmt00
IRS990/InventoriesForSaleOrUseGrp/EOYAmt00
IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt0133
IRS990/InvestmentIncomeGrp/UnrelatedBusinessRevenueAmt0133
IRS990/InvestmentInJointVentureInd00
IRS990/InvestmentsOtherSecuritiesGrp/EOYAmt00
IRS990/InvestmentsProgramRelatedGrp/EOYAmt00
IRS990/InvestmentsPubTradedSecGrp/EOYAmt00
IRS990/IRPDocumentCnt00
IRS990/IRPDocumentW2GCnt00
IRS990/LandBldgEquipBasisNetGrp/EOYAmt00
IRS990/LegalDomicileStateCd0IA
IRS990/LoanOutstandingInd00
IRS990/LocalChaptersInd00
IRS990/MaterialDiversionOrMisuseInd00
IRS990/MembersOrStockholdersInd00
IRS990/MethodOfAccountingAccrualInd0X
IRS990/MinutesOfCommitteesInd00
IRS990/MinutesOfGoverningBodyInd01
IRS990/MissionDesc0TO PAY MEDICAL CLAIMS FOR PARTICIPANTS
IRS990/MoreThan5000KToIndividualsInd00
IRS990/MoreThan5000KToOrgInd00
IRS990/NetAssetsOrFundBalancesBOYAmt0534338
IRS990/NetAssetsOrFundBalancesEOYAmt00
IRS990/NetUnrelatedBusTxblIncmAmt00
IRS990/NondeductibleContributionsInd00
IRS990/OfficerMailingAddressInd00
IRS990/OperateHospitalInd00
IRS990/Organization501cInd0X
IRS990/OrganizationFollowsSFAS117Ind0X
IRS990/OtherAssetsTotalGrp/BOYAmt025880
IRS990/OtherAssetsTotalGrp/EOYAmt00
IRS990/OtherChangesInNetAssetsAmt00
IRS990/OtherExpensesGrp/Desc0REINSURANCE PREMIUMS
IRS990/OtherExpensesGrp/Desc1ADMINISTRATIVE FEES
IRS990/OtherExpensesGrp/ManagementAndGeneralAmt092074
IRS990/OtherExpensesGrp/ProgramServicesAmt0174247
IRS990/OtherExpensesGrp/TotalAmt0174247
IRS990/OtherExpensesGrp/TotalAmt192074
IRS990/OthNotesLoansReceivableNetGrp/EOYAmt00
IRS990/PartialLiquidationInd00
IRS990/PayPremiumsPrsnlBnftCntrctInd00
IRS990/PledgesAndGrantsReceivableGrp/BOYAmt00
IRS990/PledgesAndGrantsReceivableGrp/EOYAmt00
IRS990/PoliticalCampaignActyInd00
IRS990/PrepaidExpensesDefrdChargesGrp/EOYAmt00
IRS990/PrincipalOfficerNm0NANCY CARLSON
IRS990/ProfessionalFundraisingInd00
IRS990/ProgramServiceRevenueGrp/BusinessCd0525100
IRS990/ProgramServiceRevenueGrp/BusinessCd1525100
IRS990/ProgramServiceRevenueGrp/Desc0EMPLOYER CONTRIBUTIONS
IRS990/ProgramServiceRevenueGrp/Desc1EMPLOYEE CONTRIBUTIONS
IRS990/ProgramServiceRevenueGrp/RelatedOrExemptFuncIncomeAmt0633450
IRS990/ProgramServiceRevenueGrp/RelatedOrExemptFuncIncomeAmt1524704
IRS990/ProgramServiceRevenueGrp/TotalRevenueColumnAmt0633450
IRS990/ProgramServiceRevenueGrp/TotalRevenueColumnAmt1524704
IRS990/ProhibitedTaxShelterTransInd00
IRS990/PYBenefitsPaidToMembersAmt01112086
IRS990/PYContributionsGrantsAmt00
IRS990/PYGrantsAndSimilarPaidAmt00
IRS990/PYInvestmentIncomeAmt01627
IRS990/PYOtherExpensesAmt0380381
IRS990/PYOtherRevenueAmt00
IRS990/PYProgramServiceRevenueAmt01613484
IRS990/PYRevenuesLessExpensesAmt0122644
IRS990/PYSalariesCompEmpBnftPaidAmt00
IRS990/PYTotalExpensesAmt01492467
IRS990/PYTotalProfFndrsngExpnsAmt00
IRS990/PYTotalRevenueAmt01615111
IRS990/QuidProQuoContributionsInd00
IRS990/RcvblFromDisqualifiedPrsnGrp/EOYAmt00
IRS990/RcvFndsToPayPrsnlBnftCntrctInd00
IRS990/ReceivablesFromOfficersEtcGrp/EOYAmt00
IRS990/ReconcilationRevenueExpnssAmt0-534338
IRS990/RelatedEntityInd01
IRS990/RelatedOrganizationCtrlEntInd00
IRS990/ReportInvestmentsOtherSecInd00
IRS990/ReportLandBuildingEquipmentInd00
IRS990/ReportOtherAssetsInd00
IRS990/ReportOtherLiabilitiesInd00
IRS990/ReportProgramRelatedInvstInd00
IRS990/RevenueAmt01158154
IRS990/SavingsAndTempCashInvstGrp/BOYAmt0696127
IRS990/SavingsAndTempCashInvstGrp/EOYAmt00
IRS990/ScheduleBRequiredInd00
IRS990ScheduleD/ExpensesNotReportedAmt00
IRS990ScheduleD/ExpensesNotRptFinclStmtAmt00
IRS990ScheduleD/ExpensesSubtotalAmt01692625
IRS990ScheduleD/FootnoteTextInd0X
IRS990ScheduleD/RevenueNotReportedAmt00
IRS990ScheduleD/RevenueNotReportedFinclStmtAmt00
IRS990ScheduleD/RevenueSubtotalAmt01158287
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE VEBA TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, THE VEBA TRUST'S CONTRIBUTIONS AND INCOME, NET OF EXPENSES, ARE EXEMPT FROM INCOME TAXES. THE VEBA TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE DATED JANUARY 5, 1989, AND THE PLAN ADMINISTRATOR BELIEVES THAT THE VEBA TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE VEBA TRUST WAS TERMINATED EFFECTIVE DECEMBER 31,2013. 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 ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROCESS. WITH FEW EXCEPTIONS, THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS PRIOR TO 2010.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleD/TotalExpensesPerForm990Amt01692625
IRS990ScheduleD/TotalRevenuePerForm990Amt01158287
IRS990ScheduleD/TotalRevEtcAuditedFinclStmtAmt01158287
IRS990ScheduleD/TotExpnsEtcAuditedFinclStmtAmt01692625
IRS990ScheduleJ/EquityBasedCompArrngmInd00
IRS990/ScheduleJRequiredInd01
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt0156237
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt03497
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt011977
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0FRANCIS TRAMP
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0CEO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt0171711
IRS990ScheduleJ/SeverancePaymentInd00
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0BURGESS HEALTH CORP EMPLOYEE BENEFIT TRUST DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS, OR EMPLOYEES. FRANCIS TRAMP SERVES AS THE CEO OF A RELATED ORGANIZATION, BURGESS HEALTH CENTER. HE IS COMPENSATED BY BURGESS HEALTH CENTER. HE IS TREATED AS THE TOP MANAGEMENT OFFICIAL OF BURGESS HEALTH CORP EMPLOYEE BENEFIT TRUST.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 3
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd00
IRS990ScheduleN/AssetsDistributedInd01
IRS990ScheduleN/AttorneyGeneralNotifiedInd00
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd00
IRS990ScheduleN/EmployeeOfSuccessorInd00
IRS990ScheduleN/LiabilitiesPaidInd01
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0RECEIVABLES TRANSFERRED FOR PAYMENT OF BENEFITS PAYABLE.
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine10BURGESS HEALTH CENTER
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt02013-12-31
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN0420859940
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/FairMarketValueOfAssetAmt0283955
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/IRCSectionTxt0501(C)(3)
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/MethodOfFMVDeterminationTxt0ESTIMATE OF CLAIMS INCURRED AND BENEFITS PAYABLE.
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine101600 DIAMOND STREET
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/City0ONAWA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/State0IA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCode051040
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd00
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0EFFECTIVE DECEMBER 31, 2013, THE BURGESS HEALTH CORP EMPLOYEE BENEFIT TRUST, A VOLUNTARY EMPLOYEE'S BENEFICIARY ASSOCIATION (VEBA TRUST) WAS TERMINATED. THE VEBA TRUST HELD FUNDS CONTRIBUTED BY THE EMPLOYER AND BY EMPLOYEES TO FUND BENEFITS UNDER THE PLAN. UPON TERMINATION OF THE VEBA TRUST, SELF-INSURED BENEFITS UNDER THE PLAN AND INSURANCE PREMIUMS ARE PAID BY FUNDS CONTRIBUTED BY THE EMPLOYER AND THE EMPLOYEES. PLAN DISBURSEMENTS ARE RESTRICTED TO PAYMENT OF ADMINISTRATIVE EXPENSES AND PLAN BENEFITS.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, SCHEDULE N, PART I:
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THERE ARE NO OTHER COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY, AND AS SUCH THERE WOULD BE NO CONTEMPORANEOUS DOCUMENTATION OF THOSE MEETINGS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE FORM 990 IS REVIEWED AND APPROVED BY THE CEO AND CFO OF BURGESS HEALTH CENTER BEFORE THE FORM 990 IS FILED. A COPY IS PROVIDED TO ALL BOARD MEMBERS BEFORE FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2BURGESS HEALTH CORP EMPLOYEE BENEFIT TRUST DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS, OR EMPLOYEES. THEREFORE, THERE IS NOT A PROCESS IN PLACE FOR DETERMINING COMPENSATION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE TRUST MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4BURGESS HEALTH CENTER BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE GOVERNING BODY USES THE CONFLICT OF INTEREST POLICY OF THE BURGESS HEALTH CENTER. THE TRUSTEES ARE REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD RISE TO CONFLICTS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE TRUST DOES NOT HAVE A WRITTEN WHISTLEBLOWER POLICY, BUT IT DOES USE THE POLICY OF THE BURGESS HEALTH CENTER.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7THE TRUST DOES NOT HAVE A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY, BUT IT DOES USE THE POLICY OF THE BURGESS HEALTH CENTER.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 8B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION B, LINE 11
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART XII, LINE 2C:
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION B, LINES 12A, 12B & 12C:
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART VI, SECTION B, LINE 13:
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART VI, SECTION B, LINE 14.
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine10BURGESS HEALTH CENTER
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0420859940
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt0501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd0IA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt03
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine101600 DIAMOND STREET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/City0ONAWA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/State0IA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCode051040
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd01
IRS990ScheduleR/PerformOfServicesByOtherOrgInd01
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd01
IRS990ScheduleR/TransferFromOtherOrgInd01
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TemporarilyRstrNetAssetsGrp/BOYAmt0534338
IRS990/TemporarilyRstrNetAssetsGrp/EOYAmt00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd01
IRS990/TotalAssetsBOYAmt0724287
IRS990/TotalAssetsEOYAmt00
IRS990/TotalAssetsGrp/BOYAmt0724287
IRS990/TotalAssetsGrp/EOYAmt00
IRS990/TotalCompGreaterThan150KInd01
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt0104274
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt01588351
IRS990/TotalFunctionalExpensesGrp/TotalAmt01692625
IRS990/TotalGrossUBIAmt0133
IRS990/TotalLiabilitiesBOYAmt0189949
IRS990/TotalLiabilitiesEOYAmt00
IRS990/TotalLiabilitiesGrp/BOYAmt0189949
IRS990/TotalLiabilitiesGrp/EOYAmt00
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0534338
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt00
IRS990/TotalOtherCompensationAmt015474
IRS990/TotalProgramServiceExpensesAmt01588351
IRS990/TotalProgramServiceRevenueAmt01158154
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt01158154
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt01158287
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt0133
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt0724287
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt00
IRS990/TotReportableCompRltdOrgAmt0156237
IRS990/TypeOfOrganizationTrustInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine101600 DIAMOND ST
IRS990/USAddress/City0ONAWA
IRS990/USAddress/State0IA
IRS990/USAddress/ZIPCode0510401548
IRS990/VotingMembersGoverningBodyCnt03
IRS990/VotingMembersIndependentCnt03
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02015-11-30 17:44:51Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0NANCY CARLSON
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0CFO
ReturnHeader/BusinessOfficerGrp/PhoneNum07124232311
ReturnHeader/BusinessOfficerGrp/SignatureDt02014-11-14
ReturnHeader/Filer/BusinessName/BusinessNameLine10BURGESS HEALTH CORP EMPLOYEE BENEFIT TRUST
ReturnHeader/Filer/BusinessNameControlTxt0BURG
ReturnHeader/Filer/EIN0421320408
ReturnHeader/Filer/PhoneNum07124232311
ReturnHeader/Filer/USAddress/AddressLine101600 DIAMOND ST
ReturnHeader/Filer/USAddress/City0ONAWA
ReturnHeader/Filer/USAddress/State0IA
ReturnHeader/Filer/USAddress/ZIPCode0510401548
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0476097913
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine10SEIM JOHNSON LLP
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1018081 BURT STREET SUITE 200
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/City0OMAHA
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/State0NE
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCode0680224722
ReturnHeader/PreparerPersonGrp/PhoneNum04023302660
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0BARBARA J FAJEN
ReturnHeader/ReturnTs02014-11-14T13:33:07-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02013-01-01
ReturnHeader/TaxPeriodEndDt02013-12-31
ReturnHeader/TaxYr02013

Document Assets

No mirrored PDF or thumbnail assets are attached yet.

Filings

Displayed year

2013 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
$1,158,287
Expenses
$1,692,625
Net income
-$534,338
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2013Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$1.16$1.69$0.53
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.72$0.19$0.53$1.49
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.57$0.16$0.41$1.36
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$0.35$0.19$0.16$1.52