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          <CityNm>Wichita</CityNm>
          <StateAbbreviationCd>KS</StateAbbreviationCd>
          <ZIPCd>67226</ZIPCd>
        </USAddress>
        <EIN>481169139</EIN>
        <PrimaryActivitiesTxt>Insurance Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KS</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Kansas Restaurant &amp; Hospitality Association Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ShareOfTotalIncomeAmt>87681</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>486114</ShareOfEOYAssetsAmt>
        <OwnershipPct>1</OwnershipPct>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Kansas Restaurant &amp; Hospitality Self-insurance Fund Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>3500 N Rock Rd</AddressLine1Txt>
          <AddressLine2Txt>Bldg 1300</AddressLine2Txt>
          <CityNm>Wichita</CityNm>
          <StateAbbreviationCd>KS</StateAbbreviationCd>
          <ZIPCd>67226</ZIPCd>
        </USAddress>
        <EIN>481075726</EIN>
        <PrimaryActivitiesTxt>Self Insured Workers Compensation Fund</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>KS</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <OwnershipPct>0</OwnershipPct>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>1</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Hospitality Insurance Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>a-iii</TransactionTypeTxt>
        <InvolvedAmt>56839</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Hospitality Insurance Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>a-iv</TransactionTypeTxt>
        <InvolvedAmt>9996</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Hospitality Insurance Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>o</TransactionTypeTxt>
        <InvolvedAmt>265027</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Hospitality Insurance Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>p</TransactionTypeTxt>
        <InvolvedAmt>301369</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Hospitality Insurance Services Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>s</TransactionTypeTxt>
        <InvolvedAmt>99938</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Actual FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
