2024-10-05T15:34:26-05:00 2023-12-31 Forvis Mazars LLP 111 E WAYNE STREET SUITE 600 FORT WAYNE IN 46802 990 2023-01-01 351498722 COOK GROUP HEALTH PLAN TRUST % COOK GROUP INCORPORATED COOK 8123311025 P O BOX 1608 BLOOMINGTON IN 474021608 JOHN KAMSTRA EVP & CFO 8123311025 2024-11-15 true true LAUREN R DENTON P01571860 2604604000 2024-11-15 2023 2024-10-15 13:58:12Z JOHN KAMSTRA P O BOX 1608 BLOOMINGTON IN 474021608 121173818 false X N/A X 1981 IN PROVIDE HEALTH RELATED BENEFITS TO ELIGIBLE EMPLOYEES AND DEPENDENTS OF THE COOK GROUP HEALTH PLAN 3 0 0 4 0 0 0 123360009 121171620 1185 2198 0 0 123361194 121173818 0 0 107831175 119579407 0 0 0 0 0 9302882 9380322 117134057 128959729 6227137 -7785911 7591114 9669772 7258067 17122636 333047 -7452864 PROVIDE HEALTH RELATED BENEFITS TO ELIGIBLE EMPLOYEES AND DEPENDENTS OF THE COOK GROUP HEALTH PLAN false false 121171620 PROVIDE HEALTH BENEFITS INCLUDING MEDICAL, DENTAL AND VISION TO ELIGBLE EMPLOYEES AND DEPENDENTS OF THE COOK GROUP HEALTH PLAN false false false false false false false false false false false false false false false true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 0 0 0 false false false false false false false false X 3 0 true false false false false false false true true false false true false false false false false false IN X COOK GROUP INCORPORATED 8123311025 750 DANIELS WAY BLOOMINGTON IN 47404 X JOHN KAMSTRA EVP & CFO 0.0 5.0 X 0 0 0 GREG SMITH DIRECTOR OF HR 0.0 5.0 X 0 0 0 PETE YONKMAN PRESIDENT COOK GROUP 0.0 5.0 X 0 0 0 KIM SULLIVAN CLAIMS ADMINISTRATOR 0.0 40.0 X 0 0 0 ROB SANTA BENEFITS COORDINATOR 10.0 0.0 X 0 0 0 0 0 0 0 false false false 0 0 EMPLOYER CONTRIBUTIONS 900099 96995006 96995006 PARTICIPANT CONTRIBUTIONS 900099 18032831 18032831 PRESCRIPTION REBATES 900099 5662543 5662543 STOP-LOSS REIMBURSEMENTS 900099 393995 393995 CLAIM AND MISCELLANEOUS REIMBURSEMENTS 900099 87245 87245 121171620 2198 2198 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121173818 121171620 2198 0 0 0 119579407 119579407 0 0 0 0 0 0 0 0 0 0 0 0 4933216 4933216 0 0 0 0 0 0 0 0 0 0 0 0 STOP LOSS PREMIUM 4447106 4447106 128959729 128959729 4680846 5996257 205638 207853 0 0 2320375 3077241 0 0 0 0 0 0 0 0 384255 388421 0 0 0 0 0 0 0 0 0 0 0 0 7591114 9669772 7258067 17122636 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7258067 17122636 X 0 0 0 0 333047 -7452864 333047 -7452864 7591114 9669772 -7785911 X false true X true false 121173818 121173818 121173818 119095160 119095160 9864569 9864569 128959729 PART XII, LINE 4B - OTHER ADJUSTMENTS NET CHANGE IN YEAR END CLAIMS PAYABLE AND CLAIMS INCURRED BUT NOT REPORTED (AND IMMATERIAL ROUNDING). FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS AND TRUSTEES OF THIS TRUST (THAT ARE MEMBERS OF THE GOVERNING BOARD) ARE ALSO OFFICERS OF A RELATED ORGANIZATION REPORTED ON SCHEDULE R. AS A RESULT, ALL OFFICERS AND TRUSTEES HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF FORM 990 WAS REVIEWED BY THE GOVERNING BODY PRIOR TO FINALIZATION. AFTER THE FORM IS REVIEWED AND ITS ACCURACY CONFIRMED BY INDIVIDUALS WITH DIRECT KNOWLEDGE OF THE OPERATIONS OF THE ORGANIZATION, THE FORM 990 IS FINALIZED AND PROVIDED TO A MEMBER OF THE GOVERNING BODY FOR SIGNATURE AND FILING. FORM 990, PART VI, SECTION C, LINES 18 & 19 AS UNDER REGULATIONS SECTIONS 301.6104(D)-1 THROUGH 3, THE ORGANIZATION WILL MAKE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST THE GOVERNING DOCUMENTS AND EACH ANNUAL INFORMATION RETURN (FORM 990) AND RELATED SCHEDULES AND ATTACHMENTS (INCLUDING THE AUDITED FINANCIAL STATEMENTS). IN ADDITION, THIS RETURN IS AUTOMATICALLY POSTED ON GUIDESTAR.ORG. FORM 990, PART VII THE TRUSTEES AND OFFICERS LISTED IN PART VII ON LINE 1 (A) COLUMN A LINES 1-6 ARE EMPLOYEES OF A RELATED ORGANIZATION (AS DISCLOSED ON SCHEDULE R) THAT SPONSORS THIS 501(C)(9) VEBA. HOWEVER, BECAUSE THE RELATED ORGANIZATION IS A FOR-PROFIT ORGANIZATION THAT IS NOT OWNED OR CONTROLLED DIRECTLY OR INDIRECTLY BY THIS VEBA REPORTING ORGANIZATION AND DOES NOT PROVIDE MANAGEMENT SERVICES FOR A FEE TO THIS REPORTING ORGANIZATION, COMPENSATION FROM THE RELATED ORGANIZATION (VEBA SPONSOR) IS NOT DISCLOSED AS EACH OF THE TRUSTEES LISTED ON THESE LINES ARE VOLUNTEERS WHO SERVE THE REPORTING ORGANIZATION WITHOUT COMPENSATION FROM THE REPORTING ORGANIZATION. COOK MEDICAL TECHNOLOGIES LLC PO BOX 1608 BLOOMINGTON IN 47402 273812679 COOK GROUP INCORPORATED PO BOX 1608 BLOOMINGTON IN 474021068 351084188 HOLDING CORP. IN NA C CORPORATION COOK INC PO BOX 1608 BLOOMINGTON IN 47402 351413874 N/A SABIN CORPORATION PO BOX 1608 BLOOMINGTON IN 47402 112229508 N/A COOK RESEARCH INCORPORATED PO BOX 1608 BLOOMINGTON IN 47402 351565666 N/A COOK AVIATION INC PO BOX 1608 BLOOMINGTON IN 47402 351725043 N/A SALSBURY TRAVEL SERVICE INC PO BOX 1608 BLOOMINGTON IN 47402 351500378 N/A COOK FAMILY HEALTH CENTER INC PO BOX 1608 BLOOMINGTON IN 47402 351889969 N/A COOK BIOTECH INC PO BOX 1608 BLOOMINGTON IN 47402 351960137 N/A COOK MYOSITE INC PO BOX 1608 BLOOMINGTON IN 47402 300008683 N/A K-TUBE CORPORATION PO BOX 1608 BLOOMINGTON IN 47402 952903901 N/A COOK SHARED SERVICES INC PO BOX 1608 BLOOMINGTON IN 47402 205977443 N/A MUFFIN INCORPORATED PO BOX 1608 BLOOMINGTON IN 47402 800339962 N/A MED ENGINEERING & DEVELOPMENT INSTITUTE PO BOX 1608 BLOOMINGTON IN 47402 473049436 N/A COOK BIODEVICE LLC PO BOX 1608 BLOOMINGTON IN 47402 475048868 N/A WILSON-COOK MEDICAL INC PO BOX 1608 BLOOMINGTON IN 47402 352477175 N/A COOK ANIMAL HEALTH INC PO BOX 1608 BLOOMINGTON IN 47402 452561588 N/A COOK VANDERGRIFT INC PO BOX 1608 BLOOMINGTON IN 47402 320510551 N/A CFC LLC P O BOX 1608 BLOOMINGTON IN 47402 351304061 N/A false false false false false false false false false false false false false true false false false false COOK GROUP INCORPORATED EE SH SEE BELOW PART V, LINE 1o AS THE SPONSOR OF THE ASSOCIATED WELFARE PLAN, COOK GROUP INCORPORATED EMPLOYEES MAY PROVIDE IMMATERIAL SERVICES TO THE PLAN AND THIS TRUST FROM TIME TO TIME FOR WHICH THE RELATED PARTY RECEIVES NO COMPENSATION PART III, LINE 1 THIS ENTITY IS A CONTRIBUTING EMPLOYER TO THE FILING ORGANIZATION [A SECTION 501(C)(9) VEBA] THAT IS NOT REQUIRED TO REPORT ANY INFORMATION IN BOXES (B)-(K). PART IV LINE 1 (PAGE 1) THIS ENTITY IS A CONTRIBUTING EMPLOYER TO THE FILING ORGANIZATION [A SECTION 501(C)(9) VEBA] BUT THAT THE FILING ORGANIZATION HAS NO OWNERSHIP INTEREST IN. THEREFORE, THE INFORMATION IN BOXES (d), (f)-(i) ARE NOT REQUIRED. PART IV LINES 2-7 (PAGE 1) & 1-7 (PAGES 2 & 3) THESE ENTITIES ARE CONTRIBUTING EMPLOYERS TO THE FILING ORGANIZATION [A SECTION 501(C)(9) VEBA] THAT ARE NOT REQUIRED TO REPORT ANY INFORMATION IN BOXES (b)-(i).