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OMB No 15450047
Return of Organization Exempt From Income Tax

Forfn

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
Open to-Public
benefit trust or private foundation)
Department of the Treasury
Inspection
lntemal Revenue SerVice
P The organization may have to use a copy of this return to satisfy state reporting requirements
, 20
, 2010, and ending
A For the 2010 calendar year, or tax year beginning
D Employer identification number
C Name of organization
B Check If applicable
DESERET HEALTHCARE EMPLOYEE BENEFITS TRUST
Address
Deing Busmess As
87-04 67790
change
E Telephone number
Room/surte
Number and street (or P 0 box if mail is not delivered to street address)
Name change
Inmalretum
“mm,”

pIo_ Box 45530
City or town, state or country, and ZIP + 4

:21?“
2:33:35”

Salt Lake City, Utah 84145-0530
F Name and address of pnnCIpal officer

I

Tax-exempt status

J

Website: >

I

,,
§
é
3
3

2
3

I3
:‘s‘
3

4
5
6

a,
g

0’79

DECfi

SCANJGEIE‘

(insertno)I

I4947(a)(1)or

I

I527

I Corporation I X I Tmstr—I Assocration I

I Other F

I L Year of formation 1 98 6| M State of legal domimle UT

Bnefiy describe the organization‘s missmn or most Significant aC‘UVIUeS' _T_O_ _i_m_p_rpy_e_ _o_u_r_ _Itle_m_b_e_r_'_s_ _h_e_a_l_t_h_ _a_n_q ______ __
_feeeeeie l _ we; 1 _ 9.91111 _t_h_r_o_U.9_11 32291-191199 _ 119131311 _i_n_s_u_r_er1c_e_l_ _ 11: s _ 11511513111931- _<1e_I1t_e11_ _ _ _ _ _
19§9§§99§ 1. _ assiger}: e1- 13.159.224-911 sesmbsmsyg_i_n_s_u_r_a_rtqe_l_ -6192- 1999:3939. 21851211121- _ _ _
_iesuraegsr ___________________________________________________________________________ _ _
if the organization discontinued its operations or disposed of more than 25% of its net assets
Check this box D
1
Number of voting members of the governing body (Part VI. line 1a) I I I I I I I _ I I I I I _ _ _ I I I I I I _ I 3
0
4
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
1b)
line
VI.
(Part
body
governing
Number of independent voting members of the
0
5
I
I
I
I
I
I
I
I
I
_
I
I
I
I
I
I
I
I
I
I
2a)
line
V.
(Part
2010
year
Total number of indiVIduals employed in calendar

Total number of volunteers (estimate if necessary) I I I I I I I I I I I I I I I I I I I I I I _ I I I I I I I I I 6
7a Total gross unrelated busmess revenue from Part Vlll, column (C). line 12 I I I I I I I I I I I I I I I I I I I I I 73
b Net unrelated busmess taxable income from Form 990-T. line 34 . . . . . . . . . . . . . . . . . . . . . . . . . 7b
Prior Year
8
9

Contributions and grants (Part Vlll, line 1h)I I I I I
Programservicerevenue(PartVl|l,line29)I I I I INI I I I I I__ I I IILIIII I I I
7d)I I I I I I I I I I I I
Investment income (Part Vlll, column (A). lines 3. 4
Other revenue (Part Vlll, column (A). lines 5. 6d. sense 1061137151 meg/I I79 M I I
Total revenue-add lines8through11 (must equaIP'arI Vlll, column (A). fine 12)_I.rn.;.
line's}
Grants and similar amounts paid (Part IX. column
Benefits paid to or for members (Part lX, column (4),:iine‘4fefeI‘fl1341144 I I I I‘ I

I I I

14 , 842
1 3 , 8 42
Current Year
413,151,628

395,005,425

I I I

595, 01 4

7 , 8 91 , 1 67

I I I
. , ,
12
I I I
13
I I I
14
I I I I
3 15 Salanes, other compensation, employee benefits (Part IX. column (A), lines 5-10)I
g 16a Professmnal fundraismg fees (Part IX, column (A), line He) I I I I I I I I I I I I I I I I I
b Total fundraismg expenses (Part IX, column (D), line 25) p __________________ __
Em 17 Other expenses (Part IX. column (A). lines 11a-11d, 11f-24f) I I I I I I I I I I I I I I I I
1 8 Total expenses. Add lines 13-17 (must equal Part IX, column (A). line 25) I I I I I I I I I I
19 Revenue lessexpenses Subtractline18fromline12 . . . . . . . . . . . . . . . . . . . .

1 9 , 0 4 0, 8 34
414, 641, 273

1 5 , 62 4 , 6 67
436, 667, 462

IE 10
11
2613

)4

IXI501(c)(9

G Gmss'ece'pts $
496755771471
No
Yes
“(3) '5 ""5 3 gm!) "3mm ‘0'
affiliates?
No
Yes
H(b) Are all afi'iliates included?
If 'No,“ attach a list (see Instructions)
H(c) Group exemption number D N /A

Form of organization I
Summary
1

I501(c)(3)

801—578-5628

5E
gg 20
g: 21
£5 22

Totalassets(PartX,line16) I I I _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I _ _ I _ H
Total liabilities (PartX. line 26) I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Net assets or fund balances Subtract line 21 from line 20 . . . . . . . . . . . . . . . . . .

37 6, 82 o, 127

37 7, 17 9, 8 4 5

26, 921, 344
4 O4 , 1 0 1 , 1 8 9
10,540,084
Beginnlng of Current Year

28, 885, 230
4 O 5 , 7 O 5 , 357
30, 962,105
End of Year

216,280,678

240,175,265

95,336,024
120, 944, 654

88,268,508
151, 906,757

Signature Block
Under penalties of perjury, I d clare that l have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true.
correct. and complete Declaf tiIonlof preparer (other than officer) is based on all information of which preparer has any knowledge
Sign
Here

}

H’lq‘ll
Date

I
Signfihfe'of’cfiivcer

} David K. Anderson,
Type or pnnt name and title
Pnnt/Type preparers name

CFO

&

Controller

Check it
Date
Preparer's Signature
selfPald
employed b
Preparer
. EIN p
Firms
Use Only F'rm's name ’
Ph°ne n°
Finn's address >
May the IRS discuss this retum with the preparer shown above? (see instructions) _ , , , , , , , _ , , , _ . , _ . . . . . . . .
For Paperwork Reduction Act Notice, see the separate instructions.
JSA
OE1010 1000

PTIN

I_IYes I_INo
Form 990 (2010)
94516

i ‘
l
Page2
Form 990 (2010)
Statement of Program Service Accomplishments
Check if Schedule 0 contains a response to any question in this Part III . . . . . . . . . . . . . . . . . . . . . . . . El
Briefly describe the organization's missmn

1

To

improve

our member's

health and well

being.

Did the organization undertake any Significant program sewices during the year which were not listed on
the prior Form 990 or 990-E27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," describe these new seNices on Schedule 0
3 Did the organization cease conducting, or make Significant changes in how it conducts. any program

2

i
(


4

No

DYes

No

sew'ces" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes
If "Yes," describe these changes on Schedule 0
Describe the exempt purpose achievements for each of the organization's three largest program sewices by expenses
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are reqmred to report the amount of grants and
allocations to others, the total expenses, and revenue, if any. for each program sewice reported

4a (Code: 525100

)(Expenses$

4b (Code

) (Expenses $

4c (Code:

) (Expenses 55

and health benefits

0E1020 1 000

paid

and

to participants

including grants of $

including grants of $

4d Other program sewices. (Describe in Schedule 0 )
including grants of $
(Expenses $
4 05, 7 0 5, 35 7
4e Total program service expenses >
JSA

)(Revenue$

405,705,357InC|UdInggrantsof$

Death, disability, accident
increases in reserves.

) (Revenue $

436,667,462)
the related

) (Revenue $

)

) (Revenue $

)

)
Form 990 (2010)

Page 3

#osm 990 '(2010)
Checklist of Required Schedules
Yes
Is the organization described In section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete ScheduleA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is the organization reqUIred to complete Schedule B, Schedule of Contributors? (see instructions) . . . . . . . . .

1
2

Did the organization engage in direct or indirect political campaign activmes on behalf of or in opp05ition to
candidates for public office? If "Yes," complete Schedule C, Part! . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section 501(c)(3) organizations. Did the organization engage in lobbying actIVIties, or have a section 501(h)
election in effect during the tax year? If "Yes," complete Schedule C, Pan‘ I/ . . . . . . . . . . . . . . . . . . . . . .
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or Similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part II/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization maintain any donor adVIsed funds or any Similar funds or accounts where donors have

3
4
5

6

6

X

.

7

X

.

8

X

.

9

X

VII, VIII, lX, or X as applicable
a Did the organization report an amount for land, bUIIdlngS. and equipment ifi Part X, line 10? If "Yes," complete
Schedule D. Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes, " complete Schedule D, Part VII , , , , _ , _ _ _ _ _ , _ _ _ _ ,
c Did the organization report an amount for investments-program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VI” , , , _ _ _ , , _ , , _ _ _ , _ _
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If "Yes," complete Schedule D, Part IX , _ , , , , _ _ , _ , , _ _ _ _ , _ _ , _ , _ _ _ _
e Did the organization report an amount for other liabilities in Part X. line 25? If "Yes," complete Schedule D, Pan‘X

113

X

11b

X
X

11c

X

11d
11e

X
X

_

11f

.

123

.
.
.

1 2b
13
14a

X
X
X

14b

X

15

X

16

X

17

X

.

18

X

.
.

19
203

X
X

-

20b
Form 990 (2010)

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraismg,
busmess. and program service actiVIties outSIde the United States? If "Yes," complete Schedule F, Parts I and Iv- Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or aSSIstance to any
15
organization or entity located outSIde the United States? If "Yes," complete Schedule F, Parts II and IV . . . . . . .
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or aSSistance
16
to indiViduals located outside the United States? If "Yes," complete Schedule F, Parts III and IV . . . . . . . . . . .
Did the organization report a total of more than $15,000 of expenses for profes5ional fundraismg serVices
17
on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) . . . . . . . . . . .
Did the organization report more than $15,000 total of fundraismg event gross income and contributions on
Part Vlll, lines 1c and 8a? If "Yes," complete Schedule G, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization report more than $15,000 of gross income from gaming activmes on Part Vlll, line 9a?
19
If "Yes," complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20a Did the organization operate one or more hospitals? If "Yes, " complete Schedule H . . . . . . . . . . . . . . . .
b If "Yes" to line 20a, did the organization attach its audited finanCial statements to this return? Note. Some Form
990 filers that operate one or more hospitals must attach audited financial statements (see instructions) . - - -

X

.

11

f Did the organization’s separate or consolidated finanCIal statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax posmons under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X , _ _ _ _
12 a Did the organization obtain separate, independent audited finanCial statements for the tax year? If "Yes, "
complete Schedule D, Parts XI, XII, and XIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Was the organization included in consolidated, independent audited finanaal statements for the tax year? If "Yes, " and if
the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional . . . . . . . . . . .
is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes, " complete Schedule E . . . . . . . . .
13
14a Did the organization maintain an office, employees, or agents outSide of the United States?. . . . . . . . . . . .

3

X

quaSI-endowments? If "Yes," complete Schedule D, Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If the organization's answer to any of the followmg questions is "Yes," then complete Schedule D, Parts VI,

9

X
X

5

10

8

1
2

4

the right to prowde adVIce on the distribution or investment of amounts in such funds or accounts? If "Yes,"
complete Schedule D, Part! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the enVironment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II . . . . . . . . .
Did the organization maintain collections of works of art, historical treasures, or other Similar assets? If "Yes,"
complete Schedule D, Part II/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part
X, or pl'OVlde credit counseling, debt management, credit repair, or debt negotiation serVIces? If "Yes,"
complete Schedule D, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization, directly or through a related organization, hold assets in term, permanent. or

7

No

X

18

JSA
0E1021 1 000

Page 4

Fo'rm 990 (bo'im
Part IV

Checklist of Required Schedules (continued)
Yes

21
22
23

24a

26
27

28

No

Did the organization report more than $5,000 of grants and other a55istance to governments and organizations
In the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts / and II . . . . . . . . . . . .
Did the organIzatIon report more than $5,000 of grants and other assstance to indIVIduals In the United States

21

X

on Part IX, column (A), me 2? If "Yes, " complete Schedule I, Parts I and III . . . . . . . . . . . . . . . . . . . . . .

22

X

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former offIcers, dIrectors, trustees, key employees, and highest compensated
employees? If "Yes," complete ScheduleJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization have a tax-exempt bond issue With an outstanding prinCIpal amount of more than
$100,000 as of the last day of the year, that was Issued after December 31, 2002? If "Yes," answer lines 24b

23

X

through 24d and complete Schedule K If "No," go to line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . . . . . . .
Did the organization maintain an escrow account other than a refunding escrow at any time during the year

243
24b

X
X

to defease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? . . . . . . .
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage In an excess benefIt transaction

24‘:
24d

X
X

WIth a disqualified person during the year? If "Yes," complete Schedule L, Partl . . . . . . . . . . . . . . . . . . .
Is the organization aware that It engaged In an excess benefit transactIon With a dIsqualified person In a prior
year, and that the transaction has not been reported on any of the organIzation's prior Forms 990 or 990-EZ?

253

If "Yes," complete Schedule L, Partl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25b
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or
disqualified person outstanding as of the end of the organIzatIon‘s tax year? If "Yes, " complete Schedule L Part II . 26
DId the organization prOVIde a grant or other aSSIstance to an officer, dIrector, trustee, key employee,
substantial contrIbutor, or a grant selection committee member, or to a person related to such an indiVidual?
If "Yes," complete Schedule L Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Was the organization a party to a busmess transaction WIth one of the followmg parties (see Schedule L.
Part IV instructions for appIIcabIe fIIIng thresholds, condItIons, and exceptions):

X

X

,

A current or former officer, dIrector, trustee, or key employee? If "Yes," complete Schedule L, Part IV . . . . . . . .
A famIIy member of a current or former officer, director, trustee, or key employee? If "Yes," complete

283

X

Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
An entity of thch a current or former officer, director, trustee, or key employee (or a family member thereof)

28b

X

was an officer, director, trustee, or direct or indIrect owner? If "Yes," complete Schedule L, Part IV . . . . . . . . .
Did the organIzation receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M
Did the organization receive contributIons of art, historical treasures, or other Similar assets, or qualified

286
29

29
30
31
32
33
34
35

conservation contributions? If "Yes," complete Schedule
DId the organizatIon liqUIdate, termInate, or dIssoIve
Partl . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization sell, exchange, dispose of, or
complete Schedule N, Part II . . . . . . . . . . . . . . .

M . . . . . . . . . . . . .
and cease operations? If
. . . . . . . . . . . . . . .
transfer more than 25%
. . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .
"Yes," complete Schedule N,
. . . . . . . . . . . . . . . . .
of its net assets? If "Yes,"
. . . . . . . . . . . . . . . . .

Did the organIzation own 100% of an entIty dIsregarded as separate from the organization under Regulations
sections 301 .7701-2 and 301.7701-3? If "Yes," complete Schedule R, Parfl . . . . . . . . . . . . . . . . . . . . .
Was the organIzation related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III,
IV, andV,line1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Is any related organization a controlled entity WithIn the meanIng of sectIon 512(b)(13)? _ _ _ _ . I I , _ I I _ _ _

X
X

30

X

31

X

32

X
X

33
34
35

X
X

DId the organIzation recere any payment from or engage in any transactIon WIth a
controlled entity Within the meaning of sectlon 512(b)(13)? If "Yes, " complete Schedule R,
36
37

No
Pan v, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .[Zl Yes
Section 501(c)(3) organizations. DId the organIzation make any transfers to an exempt non-charItable
related organization? If "Yes, " complete Schedule R, Part V, line 2 , , , , , , , , , , , , , , , _ , , , , , , , , _ , ,
DId the organIzatIon conduct more than 5% of its actIvities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R
Pan‘VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38

JSA
OE1030 1 000

Did the organization complete Schedule 0 and prOVIde explanations In Schedule 0 for Part VI, lines 11 and
19? Note. All Form 990 New are reqUIred to complete Schedule 0 . . . . . . . . . . . . . . . . . . . . . . . . .

36

X
X
38
Form 990 (2010)

Page 5

Form 990 (2610)
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response to any question in this Part V . . . . . . . . . . . . . . . . . . . . . .
Yes
1a Enterthe number reported In Box 3 of Form 1096 Enter -0- If not applicable I I I I I I I I I I 1a 0
b Enter the number of Forms W-2G included In line 1a Enter -0- if not applIcable I I I I I I I I I 1b 0
c Did the organizatIon comply With backup withholding rules for reportable payments to vendors and
reportable garnan (gambling) wmnlngs to prlze Winners7. . . . . . . . . . . . . . . .N./.A. . . . . . . . . . . . . .
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
23 O
Statements, filed for the calendar year ending With or Within the year covered by this return
b If at least one is reported on Me 2a, dId the organization file all reqwred federal employment tax returns?

.
1c

2b
i

Note. If the sum of lines 1a and 2a is greater than 250, you may be reqUIred to e-fi/e (see Instructions)
3a DId the organization have unrelated busmess gross income of $1 ,000 or more during the year? I I I I I I I I I I
b If "Yes," has it filed a Form 990-T for thIs year? If "No,"prowde an explanation in Schedule 0 _ I I I _ _ , , _ I I , ,
4a At any time during the calendar year, did the organization have an interest in, or a Signature or other authority
over, a finanCIal account in a foreign country (such as a bank account, securities account, or other fInanCIal

3a

X

3b

X

account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b If "Yes." enter the name of the foreign country b ggyrggrgnl_s_l§19§i_s ___________________________ __
See instructions for filing reqUIrements for Form TD F 90-22.1, Report of Foreign Bank and FinanCIal Accounts.
5a Was the organization a party to a prohibited tax shelter transactlon at any time during the tax year? I I I I I I I I
b DId any taxable party notIfy the organization that It was or is a party to a prohibited tax shelter transaction?
c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? I I , , I , . , , , . _ . . . . , . . . , _ _ , . . . .
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible? _ _ , , , , , . _ . . . . . . , , _ . . . . . . . .
b If "Yes," did the organization include With every solICItation an express statement that such contributions or

43

gifts were not tax deductlble? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Organizations that may receive deductible contributions under section 170(c).
a Did the organization weave a payment In excess of $75 made partly as a contribution and partly for goods
and serwces prowded to the payer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b If "Yes," did the organization notify the donor of the value of the goods or serwces prOVIded? I I , _ , , , I I I _ _
c Did the organIzation sell, exchange, or othenNise dispose of tangible personal property for which it was
reqUIred to file Form 8282? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6b

7

X
I,



i
5a

X

5b

X

56
X

53

gi§§< ”

X

7c

d If "Yes," indicate the number of Forms 8282 filed during the year I I , I I I I I I I I I I I I I 7d
e Did the organization receive any funds, directly or indirectly, to pay prequms on a personal benefit contract? , _ , 76
7f
f DId the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
g If the organization received a contribution of qualified Intellectual property, did the organization file Form 8899 as reqUIred? I _ I _7_g
7h
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098—C?
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting
organizations. Did the supporting organization, or a donor adVIsed fund maIntained by a sponsoring
8
organization, have excess busmess holdings at any time during the year? I I I I I I I I I I I I I I I I I I I I I I I

X
X

a
3

9a
9b
1
23.


11

13

>Ԥ

9??

9

Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders _ , _ I I , , _ , , , I . . . . . . . . .
b Gross income from other sources (Do not net amounts due or paid to other
against amounts due or received from them ) I , I I I _ I I I I I I I I I I I I I I I I
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form
b If "Yes," enter the amount of tax-exempt Interest received or accrued during the year


X

73
7b

.

Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable distributions under section 4966? , , , , , _ _ , , . _ , , . _ _ . . . . . . .
b DId the organization make a dIstributIon to a donor, donor advisor. or related person? I I I I I I I I I I I I I I I I
10 Section 501(c)(7) organizations. Enter
a InitIatIon fees and capital contributions included on Part VIII, line 12 I I I _ I I I I I I I I I I 10a
10b
b Gross receipts, Included on Form 990, Part VIII, Me 12. for public use of club faCIlities

No

. . . . .
sources
I I I I I

113
11b

990 In lieu of Form 1041?
I I I I I 12b

Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organIzatIon licensed to issue qualIfied health plans in more than one state? _ I I I I I I
Note. See the Instructions for addItional Information the organIzatIon must report on Schedule
b Enter the amount of reserves the organization is required to maintaIn by the states In which
the organIzatIon is IIcensed to Issue qualified health plans _ _ I I I I _ I I I I I I I I I I I I I
c Enter the amount of reserves on hand . _ _ _ I I I I I I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I

12a

13a

0.
13b
13c

X
14a Did the organization receive any payments for Indoor tannIng serwces during the tax year? _ , I _ _ _ _ _ , _ , , _ 143
b If "Yes," has it filed a Form 720 to report these payments? If "No, " provide an explanation in Schedule 0 . . . . . . 14b
JSA
Form 990 (2010)
0E1040 1 000

Form 990 zzbm)

Page 6

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and
for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in
Schedule 0. See instructions.
I:
Check if Schedule 0 contains a response to any question in this Part VI . . . . . . . . . . . . . . . .
Section A. Governirm Body and Management
Yes
1a
b
2
3
4
5
6
7a

Enter the number of voting members of the governing body at the end of the tax year - . - . . .
1a
1
0
1b
Enter the number of voting members included in line 1a, above, who are Independent . . . . . .
Did any officer, director, trustee, or key employee have a family relationship or a busmess relationship With
any other officer, director, trustee, or key employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization delegate control over management duties customarily performed by or under the direct
superw5ion of officers, directors or trustees, or key employees to a management company or other person? . . .
Did the organization make any Significant changes to its governing documents Since the pnor Form 990 was filed? . . . . . .
Did the organization become aware during the year of a Significant diverSIon of the organization's assets”. . . . .

Does the organization have members or stockholders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the organization have members, stockholders, or other persons who may elect one or more members
of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Are any deCi5ions of the governing body subject to approval by members, stockholders, or other persons? . . . .
8
Did the organization contemporaneously document the meetings held or written actions undertaken during
a

2

X

3
4

X
x

5

X

5

X

73

X

7b

X
_

the year by the followmg'
The governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

83

. . . . . . . . . . .

8b

Each committee with authority to act on behalf of the governing body? . . . . . . . . . . . .
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot
the organization's mailing address? If "Yes, "prowde the names and addresses in Schedule 0 .
Section B. Policies (This Section B requests information about policies not required by the
b

X
X

be reached at
. . . . . . . . . . .
9
Internal Revenue Code.)
Yes

10a
b

Does the organization have local chapters, branches, or affiliates? . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," does the organization have written pOIIC|eS and procedures governing the activmes of such chapters,
affiliates, and branches to ensure their operations are conSistent With those of the organization? . . . . . . . . . .

11a

Has the organization prowded a copy of this Form 990 to all members of its governing body before filing the
form? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Describe in Schedule 0 the process, if any, used by the organization to reVIew this Form 990.
Does the organization have a written conflict of interest policy? If "No," go to line 13 . . . . . . . . . . . . . . . .

12b

X

120

X

13

X

Does the organization have a written document retention and destruction policy? . . . . . . . . . . . . . . . . . .
Did the process for determining compensation of the followmg persons include a reView and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and deci3ion?

14

X

a

The organization's CEO, Executive Director, or top management offiCial . . . . . . . . . . . . . . . . . . . . . . .

153

X

b

Other officers or key employees of the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes" to line 15a or 15b, describe the process in Schedule 0. (See instructions.)
Did the organization invest in, contribute assets to, or partICipate in a joint venture or Similar arrangement

15b

X

With a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," has the organization adopted a written policy or procedure reqwring the organization to evaluate
its partICipation in pint venture arrangements under applicable federal tax law, and taken steps to safeguard
the organization's exempt status With respect to such arrangements? . . . . . . . . . . . . . . . . . . . . . . . .
Section C. Disclosure

163

c
13
14
15

16a

Are officers, directors or trustees, and key employees reqwred to disclose annually interests that could give
rise to conflicts? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the organization regularly and consistently monitor and enforce compliance With the policy? If "Yes, "
describe In Schedule 0 how this is done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No

10b

123

b

X

X

103

X
. .
X

b
123

No

113

,

X

b

17
18

16b

List the states With which a copy of this Form 990 is required to be filed >_N_/_}l _______________________________ __
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only)
available for public ins ection Indicate how you make these available. Check all that apply.
Upon request
Another's webSIte
Own website

19

Describe in Schedule 0 Whether (and if so, how), the organization makes its governing documents, conflict of interest

20

policy, and finanCIal statements available to the public
State the name, phy5ica| address, and telephone number of the person who possesses the books and records of the
organization: > P917311 3.699., _ _P_-_0_-_ _B_0.X_ _4_5_5_3:Qr_ is E _ 9513.6- £131.]- Pier: _ § 5 l :1 é :9§§9; _ .89_l:_5_7_8:_5_6_6_0_ _ _

0E10:ZSA1000

Form 990 (2010)

Page 7

Form 990 (2010)
Part VII

Section A.

Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees,
and Independent Contractors
Check if Schedule 0 contains a response to any question in this Part VII . . . . . . . . . . . . . . . . . . . . . [:l
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

13 Complete this table for all persons requrred to be listed. Report compensation for the calendar year ending With or wrthin the
organization's tax year
0 List all of the organization's current officers, directors, trustees (whether mdrvrduals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
0 List all of the organization's current key employees, if any See instructions for definition of "key employee "
° List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations
0 List all of the organization's former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations
° List all of the organization‘s former directors or trustees that received, in the capacrty as a former director or trustee of
the organization, more than $10,000 of reportable compensation from the organization and any related organizations
List persons in the followrng order' indivrdual
compensated employees, and former such persons.

trustees

or

directors.

institutional

trustees,

officers,

key

employees,

highest

D Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title

(B)
Average
hours per
week
(describe
hours (or
'e'a'e"
or ganizations
In Schedule
0)

_ _(_1) 1335195133- NEH-1:3}- _B_e_n_e_f_l_t______ _ _
Administrators

(C)
Posrtion (check all that apply)
9, a g g g g ;_E g
2 g g g ‘3 1% 2:; 3
:3 g '5‘ " g f, 2'. 9?
E m 8
9 g g
%rn
g
5a =
a
a
0 a
g:
‘°
CL

(D)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)

(E)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

X

"(2) 143911.519}- _S_t_ap_l_ey_____________ __
21.38

X

195,265

46,465

8.49

X

116,853

13,952

21.38

X

111,135

12,679

21.38

X

162,927

3,769

_131.83992199._Ee_l_s_t_e_d_____________ __
"(4) _D§y_i_d_ _K_._ _A_n_d_e_r_s_o_n___________ __
_ _L51 .1399. 10.11.118.031_________________ _ _
_ -le ____________________________ _ _
_ -01 ____________________________ _ _
_ -631 ____________________________ _ _
_ _L91 ____________________________ _ _
-110)____________________________ _ _
_(1_1)____________________________ _ _
-112.)____________________________ _ _
41.31)____________________________ _ _
-114.)____________________________ _ _
-115)____________________________ _ _
_ (1.6)____________________________ _ _
JSA
0E1041 1000

Form 990 (2010)

Page 8

Form 990 (2010) '
Section A. Officers, Directors, Trustees, Ke
(A)
Name and title

Employees, and Highest Compensated Employees (continued)

(C)
(B)
Positron (check all that apply)
Average
9. g '3‘; g g $555 3"
hours per
week
a g 5% g E g g 3
m 8’ " 3 E :3; 2
(descnbe
E “’ 3
i
“ E
hours for
g
3
E
related
a
8
organizations
§
m Schedule 0)
Q.

(D)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)

(E)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)

(F)
Estimated
amountof
“her
compensat'on
W” the
°’9a"'za"°"
and related
organizations

(.111 _____________________________ __
(1.3). _____________________________ __
L191 _____________________________ __
(BBL _____________________________ __
(.211 _____________________________ __
(.23). _____________________________ __
(3}). _____________________________ __
(.25). _____________________________ __
(3.5). _____________________________ __
(.255). _____________________________ __
(3.7). _____________________________ __
(.29). _____________________________ __
1b Sub-total . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Total from continuation sheets to Part VII, Section A _ _ , ,
dTotal (add lines 1band 1c) . . . . . . . . . . . . . . . . . . .
2 Total number of indivrduals (including but not limited to those
reportable compensation from the organization >

. . .
_ _ _
. . .
listed
0

. . . . . . >
. . , , , _ >
586,180
. . . . .. b
above) who received more than $100,000 in

76,865

Yes
3
4

5

r
3

Did the organization list any former officer, director or trustee. key employee, or highest compensated
employee on line 1a? If "Yes," complete Schedule J for such mdrvrdua/ . . . . . . . . . . . . . . . . . . . . . . . . . .
For any indivrdual listed on line 1a. is the sum of reportable compensation and other compensation from
the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
IndiVIduaI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or indiVidual
for servrces rendered to the organization? If "Yes," complete Schedule J for such person . . . . . . . . . . . . . . . .

A

No
‘5

X

E? “:5
r

X
4

~i
a-l

5

X

Section B. Independent Contractors
1

Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization
(A)
Name and busrness address

2

(B)
Description of servrces

(C)
Compensation

Total number of independent contractors (including but not limited to those listed above) who received
0
more than $100,000 in compensation from the organization b

JSA
0E105O 1 000

Form 990 (2010)


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