2022-09-13T12:20:53-05:00 2021-12-31 273858252 DEAN DORTON ALLEN FORD PLLC 250 W MAIN STREET STE 1400 LEXINGTON KY 40507 990 2021-01-01 136176007 BOYS & GIRLS CLUB WORKERS ASSOCIATION BOYS 4044875410 230 LEXINGTON GREEN CIRCLE STE 400 LEXINGTON KY 40503 STEPHANIE COOLEY ADMINISTRATOR 4044875410 2022-09-07 1 STEPHANIE COOLEY XXX-XX-XXXX ALLISON C CARTER P01242412 8592552341 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X DEBORAH FRIES-JACKSON 230 LEXINGTON GREEN CIRCLE STE 400 LEXINGTON KY 40503 26017926 0 X N/A X 1927 GA TO PROVIDE INSURANCE PLANS FOR PARTICIPATING EMPLOYEES OF MEMBER BOYS & GIRLS CLUBS LOCATED THROUGHOUT THE UNITED STATES 12 12 0 12 849383 0 0 0 17842636 18354202 387436 820583 52693 71344 18282765 19246129 0 0 12951396 13936968 0 0 0 0 0 5242659 5506711 18194055 19443679 88710 -197550 12238384 12308016 2083911 2360639 10154473 9947377 X TO PROVIDE LIFE, SICKNESS, ACCIDENT OR OTHER HEALTH BENEFITS TO PARTICIPATING EMPLOYEES OF MEMBER ORGANIZATIONS, GENERALLY LOCAL BOYS & GIRLS CLUBS, AFFILIATED WITH BOYS & GIRLS CLUBS OF AMERICA (THE NATIONAL ORGANIZATION), WHO MEET THE ELIGIBILITY REQUIREMENTS ESTABLISHED BY THE PLAN, PROVIDERS OF SUCH INSURANCE PLANS, AND THE PLAN ADMINISTRATOR. 0 0 13936968 18396746 MEDICAL AND SHORT-TERM DISABILITY CLAIMS PAID ON BEHALF OF PARTICIPANTS 4031537 INSURANCE PREMIUMS PAID TO CARRIERS 290800 INCREASE IN CLAIMS INCURRED BUT NOT REPORTED (IBNR) 18259305 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SAM UNGLO 4044875410 1275 PEACHTREE ST NE ATLANTA GA 30309 X DEBORAH FRIES-JACKSON CHAIRPERSON 1.50 X X 0 0 0 KEVIN DEARY VICE CHAIRPERSON 1.50 X X 0 0 0 PHYLLIS AUSTIN SECRETARY 1.50 X X 0 0 0 SAM UNGLO TREASURER 3.00 X X 0 0 0 SABRINA ANDERSON BOARD MEMBER 1.50 X 0 0 0 LISA BEILHARZ BOARD MEMBER 1.50 X 0 0 0 JERRY GLIDEWELL BOARD MEMBER 1.50 X 0 0 0 TAMMY M DUBOIS BOARD MEMBER 1.50 X 0 0 0 KATIE LEO BOARD MEMBER 1.50 X 0 0 0 JOSEPH LYNCH BOARD MEMBER 1.50 X 0 0 0 RYAN SMILEY BOARD MEMBER 1.50 X 0 0 0 MIKE WURM BOARD MEMBER 1.50 X 0 0 0 STEPHANIE COOLEY ADMINISTRATOR 2.50 X 0 0 0 0 0 0 0 0 0 0 UMR INCORPORATED 11 SCOTT STREET WAUSAU WI 54403 CLAIMS ADMINISTRATION 977333 1 PAYMENTS FROM MEMBER CLUBS 900099 18354202 18354202 18354202 305077 305077 28800 28800 7287303 6771797 515506 515506 515506 REFUNDED PREMIUMS 900099 42544 42544 42544 19246129 18396746 849383 0 13936968 13936968 16000 16000 57557 57557 20000 20000 838 838 INSURANCE PREMIUMS 4031537 4031537 ADMINISTRATIVE FEES 1073021 1073021 INCREASE IN IBNR 290800 290800 BANK FEES 16958 16958 19443679 18259305 1184374 0 280629 11146 533903 616587 5657879 7041749 5765973 4638534 12238384 12308016 668611 605519 37240 86260 1378060 1668860 2083911 2360639 X 10154473 9947377 10154473 9947377 12238384 12308016 -197550 -9545 0 X X 0 1 X 1 0 0 ISHARES CORE S&P 500 ETF - 3,430 SHS 1636076 F BAIRD AGGREGATE BOND FUND - 84,325.173 SHS 958777 F FIDELITY INVESTMENT GRADE BOND FUND - 114,676.339 SHS 960988 F DOUBLELINE TOTAL RETURN BOND FUND - 39,555.587 SHS 411378 F JOHCM INTERNATIONAL SELECT FUND - 22,325.072 SHS 671315 F 4638534 POST-RETIREMENT LIFE INSURANCE BENEFITS 2500 MEDICAL, SHORT-TERM DISABILITY AND DENTAL CLAIMS INCURRED BUT NOT REPORTED 1666360 1668860 19236584 -9545 -9545 19246129 0 19246129 19152880 0 19152880 290800 290800 19443680 PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN IBNR 290,800. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT OF FORM 990 IS FIRST REVIEWED AND APPROVED BY THE TREASURER AND THEN FORWARDED TO ALL BOARD MEMBERS FOR THEIR REVIEW AND APPROVAL. THE APPROVED FORM 990 IS FILED BY THE TREASURER. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE ASKED ANNUALLY TO NOTIFY THE CHAIRMAN OF THE BOARD REGARDING ANY CONFLICTS THAT ARISE DURING THE YEAR. IF A CONFLICT ARISES, THE BOARD MEMBER WITH THE CONFLICT IS RECUSED FROM THE DISCUSSION AND VOTE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FORM 990 AVAILABLE TO PARTICIPATING MEMBERS UPON REQUEST. PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE OF THE BOARD OF DIRECTORS THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.