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Nonprofiteer
← GRACEWORKS LUTHERAN SERVICES HEALTH BENEFIT TRUST

Form 990 for tax year 2022

Filed by GRACEWORKS LUTHERAN SERVICES HEALTH BENEFIT TRUST.

Totals

Total revenue
$9,217,667
Total expenses
$9,796,041
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$9,178,494
Investment income
$39,173
Other revenue
$0
Total assets, end of year
$1,475,648
Total liabilities, end of year
$1,137,035
Net assets or fund balances, end of year
$338,613
Program services expenses (Part IX)
not reported
Management and general expenses
not reported
Fundraising expenses
not reported
Program service expenses (Part III)
not reported

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: EMPLOYER CONTRIBUTION

    total $7,794,339 · related or exempt $7,794,339

  • 2b · Program service revenue: PARTICIPANT CONTRIBUTI

    total $1,384,155 · related or exempt $1,384,155

  • 3 · Investment income

    total $39,173 · excluded $39,173

Functional expenses

Part IX, the statement of functional expenses.

  • 4 · Benefits paid to or for members

    total $9,794,055

  • 24a · Other expenses: BANK FEES AND CHARGES

    total $1,986

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $1,571,707 · end of year $1,472,894

  • 15 · Other assets

    beginning of year $2,560 · end of year $2,754

  • 17 · Accounts payable and accrued expenses

    beginning of year $657,280 · end of year $1,137,035

  • 29 · Capital stock, trust principal or current funds

    beginning of year $916,987 · end of year $338,613

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $0 · end of year $0

Mission and programs · 2022

Mission

TO PAY MEMBER'S LIFE, SICK, ACCIDENT, OR OTHER BENEFITS.

  • LIFE, SICK, ACCIDENT, OR OTHER BENEFITS PAID FOR PARTICIPANTS OR BENEFICIARIES.

As filed on the 2022 return.

Listed in Part VII

  • JUDY A BUDI

    TRUSTEE

    Total calculated
    $401,193
    From this org
    $0
    From related orgs
    $371,988
    Other
    $29,205
    Hours/week
    0.1 + 39.9 related

    Schedule J breakdown matched by us

    Base
    $0 + $371,988 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $17,005 related
    Filer's total
    $0 + $401,193 related

  • MICHAEL W ALLEN

    TRUSTEE (UNTIL 11/08/22)

    Total calculated
    $274,093
    From this org
    $0
    From related orgs
    $257,340
    Other
    $16,753
    Hours/week
    0.1 + 39.9 related

    Schedule J breakdown matched by us

    Base
    $0 + $257,340 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $9,106 related
    Nontaxable benefits
    $0 + $7,647 related
    Filer's total
    $0 + $274,093 related

  • DAWN L BARHORST

    TRUSTEE

    Total calculated
    $184,341
    From this org
    $0
    From related orgs
    $169,426
    Other
    $14,915
    Hours/week
    0.1 + 39.9 related

    Schedule J breakdown matched by us

    Base
    $0 + $167,904 related
    Bonus
    $0
    Other
    $0 + $1,522 related
    Deferred
    $0 + $6,897 related
    Nontaxable benefits
    $0 + $8,018 related
    Filer's total
    $0 + $184,341 related

  • ROBERT A REICHARD

    TRUSTEE (AS OF 11/08/22)

    Total calculated
    $140,592
    From this org
    $0
    From related orgs
    $127,177
    Other
    $13,415
    Hours/week
    0.1 + 39.9 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement

The filer's explanations (Part III)

PART I, LINE 3
COMPENSATION IS PAID BY GRACEWORKS LUTHERAN SERVICES, A RELATED ORGANIZATION, AND IS DETERMINED USING THE FOLLOWING METHODS: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
PART I, LINE 4B:
NON-QUALIFIED DEFERRED COMPENSATION PLAN, SECTION 457(B): JUDY A. BUDI, EMPLOYEE CONTRIBUTION - $2,972, EMPLOYER CONTRIBUTION - $2,972

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
11 December 2023
IRS schema version
2022v5.0
Source object
202323499349300142

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