Genesis Health System Self Insurance Plan And Trust in Davenport, Iowa (IA)
Table of contents:
- Overview
- Detailed Reports
- Revenue, Expenses, and Changes in Net Assets or Fund Balances
- Statement of Functional Expenses
- Balance Sheets
- Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
- Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
- Current Officers, Directors, Trustees, and Key Employees
- Other Information
- Analysis of Income-Producing Activities
- Information Regarding Taxable Subsidiaries and Disregarded Entities
- Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
- Statements About Activities
- Reason for Non-Private Foundation Status
- Support Schedule
- Lobbying Expenditures by Electing Public Charities
- Organizations performing similar types of work
| Genesis Health System Self Insurance Plan And Trust | |
| Employer Identification Number (EIN) | 426522518 |
| Name of Organization | Genesis Health System Self Insurance Plan And Trust |
| Address | Davenport, IA 52803 |
| Tax Period | 2003 |
| Asset Amount | $10,095,219 |
| Amount of Income | $2,636,745 |
| Form 990 Revenue Amount | $2,636,745 |
| National Taxonomy of Exempt Entities (NTEE) | Mutual/Membership Benefit Organizations, Other: Insurance Providers, Services |
Non-representatives - add comments:
Amount of income in 2003: $2,636,745
| This organization: | $2,636,745 |
| Other organizations performing similar types of work: | $5,508,185 |
Assets in 2003: $10,095,219
| Genesis Health System Self Insurance Plan And Trust: | $10,095,219 |
| Other organizations performing similar types of work: | $22,382,791 |
Expenses in 2003: $4,384,545
| Genesis Health System Self Insurance Plan And Trust: | $4,384,545 |
| Other organizations performing similar types of work: | $4,814,604 |
Income to expenses ratio in 2003: 0.6
| This organization: | 0.6 |
| Other organizations performing similar types of work: | 1.2 |
Expenses allocated to program services in 2003: 97.7%
| This organization: | 97.7% |
| Other organizations performing similar types of work: | 0.0% |
Grants share in income in 2003: 65.3%
| This organization: | 65.3% |
| Other organizations performing similar types of work: | 0.0% |
Revenue for 2003
Assets at end of 2003
Expenses for 2003
Income-Producing Activities for 2003
| Revenue, Expenses, and Changes in Net Assets or Fund Balances | ||||
| 2000 | 2001 | 2002 | 2003 | |
|---|---|---|---|---|
| Total revenue | $2,128,831 | $2,477,751 | $2,829,692 | $2,636,745 |
| Contributions, gifts, grants, and similar amounts received | $1,334,742 | $1,619,781 | $2,045,638 | $1,721,277 |
| Contributions to donor advised funds | ||||
| Direct public support | $0 | $0 | $0 | $0 |
| Indirect public support | $1,334,742 | $1,619,781 | $2,045,638 | $1,721,277 |
| Government contributions (grants) | $0 | $0 | $0 | $0 |
| Program service revenue including government fees and contracts | $0 | $0 | $0 | $0 |
| Membership dues and assessments | $0 | $0 | $0 | $0 |
| Interest on savings and temporary cash investments | $0 | $0 | $0 | $0 |
| Dividends and interest from securities | $727,926 | $722,791 | $659,092 | $714,188 |
| Net rental income or (loss) | $0 | $0 | $0 | $0 |
| Gross rents | $0 | $0 | $0 | $0 |
| Less: rental expenses | $0 | $0 | $0 | $0 |
| Other investment income | $0 | $0 | $0 | $0 |
| Gain or (loss) from sales of assets other than inventory | $0 | $0 | $0 | $0 |
| Gross amount from sales of assets other than inventory | $0 | $0 | $0 | $0 |
| Less: cost or other basis and sales expenses | $0 | $0 | $0 | $0 |
| Net income or (loss) from special events and activities | $0 | $0 | $0 | $0 |
| Gross revenue | $0 | $0 | $0 | $0 |
| Less: direct expenses other than fundraising expenses | $0 | $0 | $0 | $0 |
| Gross profit or (loss) from sales of inventory | $0 | $0 | $0 | $0 |
| Gross sales of inventory, less returns and allowances | $0 | $0 | $0 | $0 |
| Less: cost of goods sold | $0 | $0 | $0 | $0 |
| Other revenue | $66,163 | $135,179 | $124,962 | $201,280 |
| Total expenses | $-1,307,096 | $1,413,794 | $590,585 | $4,384,545 |
| Program services | $-1,283,583 | $1,364,191 | $561,269 | $4,285,129 |
| Management and general | $-23,513 | $49,603 | $29,316 | $99,416 |
| Fundraising | $0 | $0 | $0 | $0 |
| Payments to affiliates | $0 | $0 | $0 | $0 |
| Net assets or fund balances at end of year | $8,207,495 | $9,561,088 | $12,537,439 | $10,095,219 |
| Excess or (deficit) for the year | $3,435,927 | $1,063,957 | $2,239,107 | $-1,747,800 |
| Net assets or fund balances at beginning of year | $4,350,323 | $8,207,495 | $9,561,088 | $12,537,439 |
| Other changes in net assets or fund balances | $421,245 | $289,636 | $737,244 | $-694,420 |
| Statement of Functional Expenses (for 2003) | ||||
| Total | Program services | Management and general | Fundraising | |
|---|---|---|---|---|
| Total functional expenses | $4,384,545 | $4,285,129 | $99,416 | $0 |
| Grants paid from donor advised funds | ||||
| Other grants and allocations | $0 | |||
| Specific assistance to individuals | $0 | |||
| Benefits paid to or for members | $0 | |||
| Compensation of current officers, directors, key employees, etc. | $58,317 | $58,317 | $0 | $0 |
| Compensation of former officers, directors, key employees, etc. | ||||
| Compensation and other distributions, not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) | ||||
| Salaries and wages of employees not included above | $0 | $0 | $0 | $0 |
| Pension plan contributions not included above | $0 | $0 | $0 | $0 |
| Employee benefits not included above | $0 | $0 | $0 | $0 |
| Payroll taxes | $0 | $0 | $0 | $0 |
| Professional fundraising fees | $0 | $0 | $0 | $0 |
| Accounting fees | $8,855 | $0 | $8,855 | $0 |
| Legal fees | $185 | $0 | $185 | $0 |
| Supplies | $3 | $0 | $3 | $0 |
| Telephone | $0 | $0 | $0 | $0 |
| Postage and shipping | $0 | $0 | $0 | $0 |
| Occupancy | $0 | $0 | $0 | $0 |
| Equipment rental and maintenance | $0 | $0 | $0 | $0 |
| Printing and publications | $0 | $0 | $0 | $0 |
| Travel | $0 | $0 | $0 | $0 |
| Conferences, conventions, and meetings | $0 | $0 | $0 | $0 |
| Interest | $0 | $0 | $0 | $0 |
| Depreciation, depletion, etc. | $0 | $0 | $0 | $0 |
| Other expenses not covered above | $4,317,185 | $4,226,812 | $90,373 | $0 |
| Balance Sheets | ||||
| 2000 | 2001 | 2002 | 2003 | |
|---|---|---|---|---|
| Total assets | $11,708,789 | $13,812,323 | $16,294,252 | $16,950,026 |
| Cash - non-interest-bearing | $125,782 | $367,047 | $559,724 | $358,919 |
| Savings and temporary cash investments | $0 | $0 | $0 | $0 |
| Accounts receivable less allowance for doubtful accounts | $120,815 | $152,032 | $48,181 | $27,566 |
| Pledges receivable less allowance for doubtful accounts | $0 | $0 | $0 | $0 |
| Grants receivable | $0 | $0 | $0 | $0 |
| Receivables from current and former officers, directors, trustees, and key employees | $0 | $0 | $0 | $0 |
| Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) | ||||
| Other notes and loans receivable less allowance for doubtful accounts | $0 | $0 | $0 | $0 |
| Inventories for sale or use | $0 | $0 | $0 | $0 |
| Prepaid expenses and deferred charges | $0 | $17,850 | $0 | $0 |
| Investments - publicly-traded securities | ||||
| Investments - other securities | $0 | $0 | $0 | $0 |
| Investments - land, buildings, and equipment less accumulated depreciation | $0 | $0 | $0 | $0 |
| Investments - other | $11,462,192 | $13,275,394 | $15,686,347 | $16,563,541 |
| Land, buildings, and equipment less accumulated depreciation | $0 | $0 | $0 | $0 |
| Other assets, including program-related investments | $0 | $0 | $0 | $0 |
| Total liabilities | $3,501,294 | $4,251,235 | $3,756,813 | $6,854,807 |
| Accounts payable and accrued expenses | $3,501,294 | $4,251,235 | $3,756,813 | $6,854,807 |
| Grants payable | $0 | $0 | $0 | $0 |
| Deferred revenue | $0 | $0 | $0 | $0 |
| Loans from officers, directors, trustees, and key employees | $0 | $0 | $0 | $0 |
| Tax-exempt bond liabilities | $0 | $0 | $0 | $0 |
| Mortgages and other notes payable | $0 | $0 | $0 | $0 |
| Other liabilities | $0 | $0 | $0 | $0 |
| Total liabilities and net assets/fund balances | $11,708,789 | $13,812,323 | $16,294,252 | $16,950,026 |
| Total net assets or fund balances | $8,207,495 | $9,561,088 | $12,537,439 | $10,095,219 |
| Reconciliation of Revenue per Audited Financial Statements With Revenue per Return | ||||
| 2000 | 2001 | 2002 | 2003 | |
|---|---|---|---|---|
| Total revenue | $2,128,831 | $2,477,751 | $2,829,692 | $2,636,745 |
| Total revenue, gains, and other support per audited financial statements | $2,550,076 | $2,767,387 | $3,566,936 | $1,942,325 |
| Other expenses | $421,245 | $289,636 | $737,244 | $-694,420 |
| Net unrealized gains on investments | $421,245 | $289,636 | $737,244 | $-694,420 |
| Donated services and use of facilities | $0 | $0 | $0 | $0 |
| Recoveries of prior year grants | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 |
| Other revenue | $0 | $0 | $0 | $0 |
| Investment expenses | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 |
| Reconciliation of Expenses per Audited Financial Statements With Expenses per Return | ||||
| 2000 | 2001 | 2002 | 2003 | |
|---|---|---|---|---|
| Total expenses | $-1,307,096 | $1,413,794 | $590,585 | $4,384,545 |
| Total expenses and losses per audited financial statements | $-1,307,096 | $1,413,794 | $590,585 | $4,384,545 |
| Other revenue | $0 | $0 | $0 | $0 |
| Donated services and use of facilities | $0 | $0 | $0 | $0 |
| Prior year adjustments | $0 | $0 | $0 | $0 |
| Losses | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 |
| Other expenses | $0 | $0 | $0 | $0 |
| Investment expenses | $0 | $0 | $0 | $0 |
| Other | $0 | $0 | $0 | $0 |
| Current Officers, Directors, Trustees, and Key Employees |
| Total number of officers, directors, and trustees permitted to vote on organization business at board meetings | 0 |
| Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, related to each other through family or business relationships? | |
| Do any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, receive compensation from any other organizations, whether tax exempt or taxable, that are related to the organization? | |
| Does the organization have a written conflict of interest policy? |
| Other Information | |
| Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return, and has it filed a tax return on Form 990-T for this year? | No |
| Was there a liquidation, dissolution, termination, or substantial contraction during the year? | No |
| Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? | |
| Direct and indirect political expenditures | $0 |
| Did the organization file Form 1120-POL for this year? | No |
| Were substantially all dues nondeductible by members? | |
| Did the organization make only in-house lobbying expenditures of $2,000 or less? | |
| Dues, assessments, and similar amounts from members | $0 |
| Section 162(e) lobbying and political expenditures | $0 |
| Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices | $0 |
| Taxable amount of lobbying and political expenditures | $0 |
| Does the organization elect to pay the section 6033(e) tax on the amount above? | |
| If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount above to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? | |
| Initiation fees and capital contributions | $0 |
| Gross receipts for public use of club facilities | $0 |
| At any time during the year, did the organization, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)? | |
| Amount of tax imposed on the organization during the year under: section 4911 | $0 |
| Amount of tax imposed on the organization during the year under: section 4912 | $0 |
| Amount of tax imposed on the organization during the year under: section 4955 | $0 |
| Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? | No |
| Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 | $0 |
| Amount of tax above, reimbursed by the organization | $0 |
| At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? | |
| Did the organization acquire a direct or indirect interest in any applicable insurance contract? | |
| Did the supporting organization, or a fund maintained by a sponsoring organization, have excess business holdings at any time during the year? | |
| Number of employees employed in the pay period that includes March 12, 2006 | 0 |
| Analysis of Income-Producing Activities (for 2003) | |||||
| Unrelated business income | Excluded by section 512, 513, or 514 | Related or exempt function income | |||
|---|---|---|---|---|---|
| Business code | Amount | Exclusion code | Amount | ||
| Total | $0 | $915,468 | $0 | ||
| Program service revenue | |||||
| Program service revenue 1 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 2 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 3 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 4 | 000000 | $0 | 00 | $0 | $0 |
| Program service revenue 5 | 000000 | $0 | 00 | $0 | $0 |
| Medicare/Medicaid payments | 000000 | $0 | 00 | $0 | $0 |
| Fees and contracts from government agencies | 000000 | $0 | 00 | $0 | $0 |
| Membership dues and assessments | 000000 | $0 | 00 | $0 | $0 |
| Interest on savings and temporary cash investments | 000000 | $0 | 00 | $0 | $0 |
| Dividends and interest from securities | 000000 | $0 | Dividends, interest, payments with respect to securities loans, annuities, income from notional principal contracts, loan commitment fees, and other substantially similar income from ordinary and routine investments excluded by section 512(b)(1) | $714,188 | $0 |
| Net rental income or (loss) from real estate | |||||
| debt-financed property | 000000 | $0 | 00 | $0 | $0 |
| not debt-financed property | 000000 | $0 | 00 | $0 | $0 |
| Net rental income or (loss) from personal property | 000000 | $0 | 00 | $0 | $0 |
| Other investment income | 000000 | $0 | 00 | $0 | $0 |
| Gain or (loss) from sales of assets other than inventory | 000000 | $0 | 00 | $0 | $0 |
| Net income or (loss) from special events | 000000 | $0 | 00 | $0 | $0 |
| Gross profit or (loss) from sales of inventory | 000000 | $0 | 00 | $0 | $0 |
| Other revenue | 000000 | $0 | Section 501(c)(3) organization - Income from an activity carried on primarily for the convenience of the organization's members, students, patients, visitors, officers, or employees (hospital parking lot or museum cafeteria, for example) (section 513(a)(2)) | $201,280 | $0 |
| Information Regarding Taxable Subsidiaries and Disregarded Entities (for 2003) | |||
| EIN of corporation, partnership, or disregarded entity | Percentage of ownership interest | Total income | End-of-year assets |
|---|---|---|---|
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| 0% | $0 | $0 | |
| Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (for 2003) | ||
| Compensation | Contributions to employee benefit plans & deferred compensation | Expense account and other allowances |
|---|---|---|
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| $0 | $0 | $0 |
| Total number of other employees paid over $50,000 | 0 |
| Statements About Activities (for 2003) | |
| Expenses paid or incurred in connection with the lobbying activities | $0 |
| Did the organization receive or hold an easement for conservation purposes, including easements to preserve open space, the environment, historic land areas or historic structures? | |
| Did the organization provide credit counseling, debt management, credit repair, or debt negotiation services? | |
| Did the organization maintain any donor advised funds? | |
| Did the organization make any taxable distributions under section 4966? | |
| Did the organization make a distribution to a donor, donor advisor, or related person? | |
| The total number of donor advised funds owned at the end of the tax year | |
| The aggregate value of assets held in all donor advised funds owned at the end of the tax year | |
| The total number of separate funds or accounts owned at the end of the tax year (excluding donor advised funds included above) where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts | |
| The aggregate value of assets held in all funds or accounts included above at the end of the tax year | |
| Reason for Non-Private Foundation Status | |
| The organization is not a private foundation because it is | Not controlled by disqualified persons/supports non private foundation |
| Support Schedule | ||||
| 1999 | 2000 | 2001 | 2002 | |
|---|---|---|---|---|
| Total | $0 | $0 | $0 | $0 |
| Gifts, grants, and contributions received | $0 | $0 | $0 | $0 |
| Membership fees received | $0 | $0 | $0 | $0 |
| Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc., purpose | $0 | $0 | $0 | $0 |
| Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 | $0 | $0 | $0 | $0 |
| Net income from unrelated business activities not included above | $0 | $0 | $0 | $0 |
| Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf | $0 | $0 | $0 | $0 |
| The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge | $0 | $0 | $0 | $0 |
| Other income | $0 | $0 | $0 | $0 |
| Lobbying Expenditures by Electing Public Charities (for 2003) | |
| Total exempt purpose expenditures | $0 |
| Total lobbying expenditures | $0 |
| Total lobbying expenditures to influence public opinion (grassroots lobbying) | $0 |
| Total lobbying expenditures to influence a legislative body (direct lobbying) | $0 |
| Other exempt purpose expenditures | $0 |
| Lobbying nontaxable amount | $0 |
| Grassroots nontaxable amount | $0 |
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| Id | Name | Address | State | Established | Total Income |
|---|---|---|---|---|---|
| 1 | Michigan Catastrophic Claims Association U S | 17584 Laurel Park Dr Ste 350, Livonia, MI 48152-3982 | MI | 1979-04 | $3,784,547,880 |
| 2 | Delta Dental Of Illinois | 111 Shuman Blvd, Naperville Il, IL 60563-8677 | IL | 1968-05 | $657,442,282 |
| 3 | Delta Dental Of Tennessee | 240 Venture Cir, Nashville, TN 37228-1604 | TN | 1988-06 | $434,211,415 |
| 4 | Florida Insurance Guaranty Association Inc | PO BOX 14249, Tallahassee, FL 32317-4249 | FL | 1973-05 | $418,365,927 |
| 5 | The Life Insurance Company Guaranty Corporation Of New York | Att Myron Schlanger Mutual Of Ameri, New York, NY 10022 | NY | $395,633,478 | |
| 6 | Lokahi Assurance Ltd | One Kaiser Plaza 15l, Oakland, CA 94612-3610 | CA | 2003-09 | $338,423,408 |
| 7 | Chp Liability Self-Insurance Tr | Local, Boston, MA 02206-0001 | MA | 1977-11 | $261,777,978 |
| 8 | Delta Dental Of Iowa | 9000 Northpark Dr, Johnston, IA 50131-4817 | IA | 1972-01 | $88,264,336 |
| 9 | Iowa State Association Of Counties | 5500 Westown Pkwy Ste 190, Wdm, IA 50266-8364 | IA | 1973-02 | $32,008,035 |
| 10 | Utah Life & Health Insurance Guaranty Association | 60 East South Temple, Salt Lake City, UT 84111-1004 | UT | 1980-07 | $5,015,776 |
| 11 | Genesis Health System Self Insurance Plan And Trust | Davenport, IA 52803 | IA | $2,636,745 | |
| 12 | Nonprofit Insurance Trust | 21034 Heron Way Ste 107, Lakeville, MN 55044-8094 | MN | 2012-12 | $30,457,761 |
| 13 | Terrafirma Risk Retention Group Llc, Terrafirma | 100 Bank St Ste 610, Burlington, VT 05401-4946 | VT | 2012-05 | $2,412,439 |
| 14 | Heartland Risk Management Company | 2300 N Edward St, Decatur, IL 62526-4163 | IL | 2014-10 | $2,036,220 |
| 15 | Republic Risk Retention Group | 1180 Sam Rittenberg Blvd Ste 235, Charleston, SC 29407-3384 | SC | 2005-11 | $698,365 |
| 16 | United Cerebral Palsy Association Of Phila & Vcnty Workers Comp Tr | 500 N Gulph Rd Ste 450, Kng Of Prussa, PA 19406-2816 | PA | 1996-05 | $250,478 |
| 17 | Cooportunity Health | 2700 Westown Parkway Suite 345, West Des Moines, IA 50266-1411 | IA | 2012-10 | $85,946 |
| 18 | Land Of Lincoln Mutual Health Insurance Company | 222 S Riverside Plz Ste 1900, Chicago, IL 60606-6010 | IL | 2013-11 | $43,926 |
| 19 | Healthyct Inc | 35 Thorpe Ave Ste 104, Wallingford, CT 06492-1948 | CT | 2013-01 | $30,259 |
| 20 | Health Republic Insurance Of New York Corp | 30 Broad St Fl 7, New York, NY 10004-2973 | NY | 2013-03 | $29,728 |
| Number of organizations performing similar types of work | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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