TY 2017 Form 990

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

INTL UNION OF OPERATING ENGINEERS LOCAL
399 HEALTH REIMBURSEMENT ACCOUNT PLAN

Employer identification number

47-1259234

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..		0

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1	2,041,328
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e	0
3	Subtract line 2e from line 1..................		3	2,041,328
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5	2,041,328

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1	106,928
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e	0
3	Subtract line 2e from line 1...................		3	106,928
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	106,928

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.

Return Reference

Explanation

PART X, LINE 2:

ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

INTL UNION OF OPERATING ENGINEERS LOCAL
399 HEALTH REIMBURSEMENT ACCOUNT PLAN

Employer identification number

47-1259234

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BRIAN E HICKEY TRUSTEE	(i) (ii)	0 ------------- 171,093	0 ------------- 0	0 ------------- 2,826	0 ------------- 35,389	0 ------------- 14,407	0 ------------- 223,715	0 ------------- 0
2VALERIE JO COLVETT TRUSTEE	(i) (ii)	0 ------------- 142,324	0 ------------- 0	0 ------------- 314	0 ------------- 35,439	0 ------------- 14,407	0 ------------- 192,484	0 ------------- 0
3WILLIAM MASTERSON TRUSTEE	(i) (ii)	0 ------------- 153,563	0 ------------- 0	0 ------------- 678	0 ------------- 34,718	0 ------------- 14,407	0 ------------- 203,366	0 ------------- 0
4CARRIE GATH FUND ADMINISTRATOR	(i) (ii)	0 ------------- 145,218	0 ------------- 0	0 ------------- 0	0 ------------- 27,078	0 ------------- 14,157	0 ------------- 186,453	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

INTL UNION OF OPERATING ENGINEERS LOCAL
399 HEALTH REIMBURSEMENT ACCOUNT PLAN

Employer identification number

47-1259234

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 8B	THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11B	THE FUND ADMINISTRATOR IS RESPONSIBLE FOR THE REVIEW AND FILING OF THE FORM 990. A COPY OF THE FINAL FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C	THE TRUSTEES EXPECT PERSONS INVOLVED WITH THE PLAN TO FULLY DISCLOSE ANY RELATIONSHIPS WITH OTHER PARTIES THAT DEAL WITH THE PLAN. ANNUAL DISCLOSURE OF CONFLICT OF INTEREST IS MONITORED AT REGULARLY CONVENED BOARD OF TRUSTEE MEETINGS.
FORM 990, PART VI, SECTION B, LINE 15A	SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

INTL UNION OF OPERATING ENGINEERS LOCAL
399 HEALTH REIMBURSEMENT ACCOUNT PLAN

Employer identification number

47-1259234

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)INT'L UNION OF OPERATING ENGINEERS L 399 H&W TRUST 2260 S GROVE ST CHICAGO,IL60616 36-6198426	PROVIDE HEALTH CARE BENEFITS FOR ELIGIBLE PARTICIPANTS	IL	501(C)(9)		N/A		No
(2)INTERNATIONAL UNION OF OPERATING ENGINEERS LOCAL 399	CONTRIBUTING EMPLOYER						No
(3)INTERNATIONAL UNION OF OPERATING ENGINEERS LOCAL 399 EDUCATION TRAINING FUN	CONTRIBUTING EMPLOYER						No
(4)A SAFE HAVEN FOUNDATION	CONTRIBUTING EMPLOYER						No
(5)AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS	CONTRIBUTING EMPLOYER						No
(6)CHICAGO TEACHERS UNION FOUNDATION	CONTRIBUTING EMPLOYER						No
(7)CHICAGO TEMPLE	CONTRIBUTING EMPLOYER						No
(8)COLUMBIA COLLEGE	CONTRIBUTING EMPLOYER						No
(9)DOMINICAN UNIVERSITY	CONTRIBUTING EMPLOYER						No
(10)EPIC ACADEMY	CONTRIBUTING EMPLOYER						No
(11)IITKENT LAW SCHOOL	CONTRIBUTING EMPLOYER						No
(12)LORETTO HOSPITAL	CONTRIBUTING EMPLOYER						No
(13)ROOSEVELT UNIVERSITY	CONTRIBUTING EMPLOYER						No
(14)UNIVERSITY CLUB OF CHICAGO	CONTRIBUTING EMPLOYER						No
(15)WOMANS ATHLETIC CLUB	CONTRIBUTING EMPLOYER						No
(16)CITY OF CENTRALIA ILLINOIS	CONTRIBUTING EMPLOYER						No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) 122 PROPERTY LLC	CONTRIBUTING EMPLOYER							No
(2) 1237 WEST LLC ILLINOIS LIMITED LIABILITY COMPANY	CONTRIBUTING EMPLOYER							No
(3) 135 SOUTH LASALLE PROPERTY LLC	CONTRIBUTING EMPLOYER							No
(4) 199 EAST LAKE SHORE BUILDING CORPORATION	CONTRIBUTING EMPLOYER							No
(5) 2 TRANSAM LLC	CONTRIBUTING EMPLOYER							No
(6) 30 NORTH LASALLE PARTNERS LLC	CONTRIBUTING EMPLOYER							No
(7) 300 WEST ADAMS MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(8) 33 WEST MONROE ASSOCIATES LLC	CONTRIBUTING EMPLOYER							No
(9) 332 PROPERTY LLC	CONTRIBUTING EMPLOYER							No
(10) 360 MANAGEMENT COMPANY LLC	CONTRIBUTING EMPLOYER							No
(11) 39 CHICAGO MASTER TENANT LLC	CONTRIBUTING EMPLOYER							No
(12) 4220 KILDARE LLC	CONTRIBUTING EMPLOYER							No
(13) 680 NORTH LAKE SHORE ASSOCIATIONS	CONTRIBUTING EMPLOYER							No
(14) 700 N MICHIGAN LLC	CONTRIBUTING EMPLOYER							No
(15) A & A MAINTENANCE	CONTRIBUTING EMPLOYER							No
(16) A J R BUILDING INC	CONTRIBUTING EMPLOYER							No
(17) ABLE ENGINEERING SERVICES	CONTRIBUTING EMPLOYER							No
(18) ABM ONSITE SERVICES	CONTRIBUTING EMPLOYER							No
(19) ACCESSO SERVICES LLC	CONTRIBUTING EMPLOYER							No
(20) ACE HOTEL	CONTRIBUTING EMPLOYER							No
(21) ACERO SCHOOLS INC	CONTRIBUTING EMPLOYER							No
(22) AEGIS PROPERTIES	CONTRIBUTING EMPLOYER							No
(23) AMBRIDGE HOSPITALITY	CONTRIBUTING EMPLOYER							No
(24) AMCRAFT CONSTRUCTION CO INC	CONTRIBUTING EMPLOYER							No
(25) AMERITUS 211 WEST WACKER LLC	CONTRIBUTING EMPLOYER							No
(26) ANCHOR MECHANICAL INC	CONTRIBUTING EMPLOYER							No
(27) ANVAN MIDWEST REALTY MANAGEMENT CO	CONTRIBUTING EMPLOYER							No
(28) ARAMARK MANAGEMENT SERVICES LTD	CONTRIBUTING EMPLOYER							No
(29) ARBORETUM LAKES EMPLOYMENT LLC	CONTRIBUTING EMPLOYER							No
(30) ARLINGTON PARK	CONTRIBUTING EMPLOYER							No
(31) ARTHUR GOLDNER AND ASSOCIATES	CONTRIBUTING EMPLOYER							No
(32) ASHLAND MANAGEMENT AGENCY INC	CONTRIBUTING EMPLOYER							No
(33) ASPIRE PROPERTIES	CONTRIBUTING EMPLOYER							No
(34) AVISON YOUNG MANAGEMENT SERVICES	CONTRIBUTING EMPLOYER							No
(35) BARTKOWSKI LIFE SAFETY CORP	CONTRIBUTING EMPLOYER							No
(36) BEST WESTERN GRANT PARK	CONTRIBUTING EMPLOYER							No
(37) BEVARA BUILDING SERVICES	CONTRIBUTING EMPLOYER							No
(38) BIHUN COMMERCIAL SERVICES INC	CONTRIBUTING EMPLOYER							No
(39) BLUEGREEN VACATIONS CORPORATION	CONTRIBUTING EMPLOYER							No
(40) BRI 1865 HIGHLAND OAKS I LLC	CONTRIBUTING EMPLOYER							No
(41) BROADWAY IN CHICAGO LLC	CONTRIBUTING EMPLOYER							No
(42) C & W SERVICES	CONTRIBUTING EMPLOYER							No
(43) CR ADLAKE LIMITED PARTNERSHIP	CONTRIBUTING EMPLOYER							No
(44) CAPITAL 22 LLC	CONTRIBUTING EMPLOYER							No
(45) CASSIDY TURLEY COMMERCIAL REAL ESTATE SVCS INC	CONTRIBUTING EMPLOYER							No
(46) CBRE TECHNICAL SERVICES LLC	CONTRIBUTING EMPLOYER							No
(47) CBRE INC	CONTRIBUTING EMPLOYER							No
(48) CENTURY TOWER CONDOMINIUM ASSN	CONTRIBUTING EMPLOYER							No
(49) CHICAGO CUBS BASEBALL CLUB LLC	CONTRIBUTING EMPLOYER							No
(50) CHICAGO HOUSING AUTHORITY	CONTRIBUTING EMPLOYER							No
(51) CHICAGO MANAGEMENT CORP	CONTRIBUTING EMPLOYER							No
(52) CMC MAINTENANCE INC	CONTRIBUTING EMPLOYER							No
(53) COLLIERS INTERNATIONAL ASSET AND PROPERTY MGMT LLC	CONTRIBUTING EMPLOYER							No
(54) COMBINED WAREHOUSE COMPANY LLC	CONTRIBUTING EMPLOYER							No
(55) COMPREHENSIVE CONSTRUCTION SOLUTIONS LLC	CONTRIBUTING EMPLOYER							No
(56) CONGRESS PLAZA HOTEL	CONTRIBUTING EMPLOYER							No
(57) CORE MECHANICAL INC	CONTRIBUTING EMPLOYER							No
(58) CPO HOSPITALITY LLC	CONTRIBUTING EMPLOYER							No
(59) CRAYTON MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(60) CRESCENT HEIGHTS	CONTRIBUTING EMPLOYER							No
(61) CRESCENT HOTELS & RESORTS LLC	CONTRIBUTING EMPLOYER							No
(62) CRESTLINE HOTELS AND RESORTS	CONTRIBUTING EMPLOYER							No
(63) CROSSROADS HOSPITALITY COMPANY INC	CONTRIBUTING EMPLOYER							No
(64) CROWNE PLAZA CHICAGO METRO	CONTRIBUTING EMPLOYER							No
(65) CUMBERLAND CENTRE LLC	CONTRIBUTING EMPLOYER							No
(66) CUSHMAN & WAKEFIELD	CONTRIBUTING EMPLOYER							No
(67) CUSHMAN & WAKEFIELD NATIONAL	CONTRIBUTING EMPLOYER							No
(68) DAVIDSON HOTEL COMPANY	CONTRIBUTING EMPLOYER							No
(69) DEIL ASSOCIATE LLC	CONTRIBUTING EMPLOYER							No
(70) DOUBLETREE BY HILTON CHICAGO OAK BROOK	CONTRIBUTING EMPLOYER							No
(71) DRAKE HOTEL CHICAGO	CONTRIBUTING EMPLOYER							No
(72) DRAKE TOWER APARTMENTS	CONTRIBUTING EMPLOYER							No
(73) DRAPER AND KRAMER	CONTRIBUTING EMPLOYER							No
(74) DRIFTWOOD HOSPITALITY MGMT LLC	CONTRIBUTING EMPLOYER							No
(75) DUS MANAGEMENT INC	CONTRIBUTING EMPLOYER							No
(76) EAST BANK CLUB	CONTRIBUTING EMPLOYER							No
(77) EAST BELLEVUE OWNERS LLC	CONTRIBUTING EMPLOYER							No
(78) EAST LAKE MGMT DEVELOP CORP	CONTRIBUTING EMPLOYER							No
(79) EMBASSY SUITES CHGO DWNTWN LAKEFRONT	CONTRIBUTING EMPLOYER							No
(80) EMCOR FACILITIES SERVICES INC	CONTRIBUTING EMPLOYER							No
(81) ENWAVE CHICAGO LLC	CONTRIBUTING EMPLOYER							No
(82) FAIRMONT HOTEL	CONTRIBUTING EMPLOYER							No
(83) FINE ARTS LLC	CONTRIBUTING EMPLOYER							No
(84) FIRST SERVICE RESIDENTIAL	CONTRIBUTING EMPLOYER							No
(85) FRANKLIN MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(86) GARRETT CONSTRUCTION INC	CONTRIBUTING EMPLOYER							No
(87) GF MANAGEMENT	CONTRIBUTING EMPLOYER							No
(88) GK PROPERTY PARTNERS LLC	CONTRIBUTING EMPLOYER							No
(89) GLAVIN SECURITY SPECIALISTS	CONTRIBUTING EMPLOYER							No
(90) GNP MANAGEMENT GROUP	CONTRIBUTING EMPLOYER							No
(91) GRE PRAIRIE GLEN LLC	CONTRIBUTING EMPLOYER							No
(92) GROUP FOX MANAGEMENT	CONTRIBUTING EMPLOYER							No
(93) GWS LLC	CONTRIBUTING EMPLOYER							No
(94) HABITAT COMPANY	CONTRIBUTING EMPLOYER							No
(95) HAMILTON PARTNERS INC	CONTRIBUTING EMPLOYER							No
(96) HAMPTON INN & SUITES CHICAGO RIVER NORTH	CONTRIBUTING EMPLOYER							No
(97) HARD ROCK HOTEL	CONTRIBUTING EMPLOYER							No
(98) HCP OXFORD CAPITAL OBG HOTEL WACKER PROP COMP LLC	CONTRIBUTING EMPLOYER							No
(99) HCP OXFORD CAPITAL OBGCASS PROP COMP LLC	CONTRIBUTING EMPLOYER							No
(100) HCP OXFORD CAPITAL OBGGODFREY	CONTRIBUTING EMPLOYER							No
(101) HEI HOTELS AND RESORTS	CONTRIBUTING EMPLOYER							No
(102) HERSHA HOSPITALITY MANAGEMENT	CONTRIBUTING EMPLOYER							No
(103) HIGHGATE HOTELS	CONTRIBUTING EMPLOYER							No
(104) HILTON CHICAGO & TOWERS	CONTRIBUTING EMPLOYER							No
(105) HILTON HOTELS CORPORATION	CONTRIBUTING EMPLOYER							No
(106) HILTON MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(107) HILTON ROSEMONT	CONTRIBUTING EMPLOYER							No
(108) HINES	CONTRIBUTING EMPLOYER							No
(109) HINES GS PROPERTIES INC	CONTRIBUTING EMPLOYER							No
(110) HOSPITALITY STAFFING INC	CONTRIBUTING EMPLOYER							No
(111) HOTEL ALLEGRO CHICAGO	CONTRIBUTING EMPLOYER							No
(112) HYATT CORPORATION	CONTRIBUTING EMPLOYER							No
(113) IMPERIAL REALTY COMPANY	CONTRIBUTING EMPLOYER							No
(114) INSITE REAL ESTATE LLC	CONTRIBUTING EMPLOYER							No
(115) INTER CAPITAL REALTY	CONTRIBUTING EMPLOYER							No
(116) INTER CONTINENTAL REAL ESTATE & DEVELOPMENT CORP	CONTRIBUTING EMPLOYER							No
(117) INTERACTIVE BUILDING SOLUTIONS	CONTRIBUTING EMPLOYER							No
(118) INTERCONTINENTAL CHICAGO	CONTRIBUTING EMPLOYER							No
(119) INTERSTATE MANAGEMENT COMPANY LLC	CONTRIBUTING EMPLOYER							No
(120) IS CHICAGO MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(121) ISS FACILITY SERVICES INC	CONTRIBUTING EMPLOYER							No
(122) J & J ARNACO LLC	CONTRIBUTING EMPLOYER							No
(123) JACKSON MANAGEMENT AND INVEST COMP	CONTRIBUTING EMPLOYER							No
(124) JH LIFE INSURANCE COMPANY USA	CONTRIBUTING EMPLOYER							No
(125) JL WOODE MANAGEMENT COMPANY LLC	CONTRIBUTING EMPLOYER							No
(126) JMG REALTY INC	CONTRIBUTING EMPLOYER							No
(127) JOHN HANCOCK LIFE INSURANCE COMPANY USA	CONTRIBUTING EMPLOYER							No
(128) JOHNSON CONTROLS INC	CONTRIBUTING EMPLOYER							No
(129) JONES LANG LA SALLE	CONTRIBUTING EMPLOYER							No
(130) KALABICH MANAGEMENT	CONTRIBUTING EMPLOYER							No
(131) KHRG STATE STREET LLC	CONTRIBUTING EMPLOYER							No
(132) KING GEORGE	CONTRIBUTING EMPLOYER							No
(133) KROESCHELL SERVICE INC	CONTRIBUTING EMPLOYER							No
(134) L J SHERIDAN & CO	CONTRIBUTING EMPLOYER							No
(135) LIEBERMAN MANAGEMENT SERVICES INC	CONTRIBUTING EMPLOYER							No
(136) LINCOLN PROPERTY COMPANY	CONTRIBUTING EMPLOYER							No
(137) L-O CHICAGO OPERATING LLC	CONTRIBUTING EMPLOYER							No
(138) LOEWS COH OPERATING COMPANY LLC	CONTRIBUTING EMPLOYER							No
(139) LYRIC OPERA OF CHICAGO	CONTRIBUTING EMPLOYER							No
(140) M & J WILKOW LTD	CONTRIBUTING EMPLOYER							No
(141) MAC MANAGEMENT	CONTRIBUTING EMPLOYER							No
(142) MADISON SERVICES INC	CONTRIBUTING EMPLOYER							No
(143) MARC REALTY	CONTRIBUTING EMPLOYER							No
(144) MARRIOTT INTERNATIONAL INC	CONTRIBUTING EMPLOYER							No
(145) MB REAL ESTATE	CONTRIBUTING EMPLOYER							No
(146) MCCORMACK BARON MANAGEMENT	CONTRIBUTING EMPLOYER							No
(147) MERCHANDISE MART PROPERTIES	CONTRIBUTING EMPLOYER							No
(148) MERIDIAN MANAGEMENT CORP	CONTRIBUTING EMPLOYER							No
(149) MERITEX	CONTRIBUTING EMPLOYER							No
(150) METROPOLITAN PIER & EXPO AUTH	CONTRIBUTING EMPLOYER							No
(151) MIDWAY BUILDING SERVICES	CONTRIBUTING EMPLOYER							No
(152) MILLENNIUM KNICKERBOCKER HOTEL	CONTRIBUTING EMPLOYER							No
(153) MILLENNIUM PARK LIVING INC	CONTRIBUTING EMPLOYER							No
(154) MONTAUK COMPANY	CONTRIBUTING EMPLOYER							No
(155) NAI HIFFMAN ASSET MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(156) NAVY PIER INC	CONTRIBUTING EMPLOYER							No
(157) NEWMARK GRUBB KNIGHT FRANK	CONTRIBUTING EMPLOYER							No
(158) NORTH RIVERSIDE PARK ASSOCIATES LLC	CONTRIBUTING EMPLOYER							No
(159) OBT I LP	CONTRIBUTING EMPLOYER							No
(160) OLD ORCHARD WOOD MANAGEMENT	CONTRIBUTING EMPLOYER							No
(161) OMNI CHICAGO HOTEL	CONTRIBUTING EMPLOYER							No
(162) ONE EAST WACKER PARTNERS LLC	CONTRIBUTING EMPLOYER							No
(163) ONNI 200 LASALLE LIMITED PARTNERSHIP	CONTRIBUTING EMPLOYER							No
(164) ONTARIO PLACE CONDOMINIUM ASSN	CONTRIBUTING EMPLOYER							No
(165) ORCHESTRA HALL	CONTRIBUTING EMPLOYER							No
(166) OXFORD HOTELS & RESORTS LLC	CONTRIBUTING EMPLOYER							No
(167) PACIFIC MANAGEMENT INC	CONTRIBUTING EMPLOYER							No
(168) PALMOLIVE BUILDING CONDOMINIUM ASSN	CONTRIBUTING EMPLOYER							No
(169) PARK HYATT CHICAGO	CONTRIBUTING EMPLOYER							No
(170) PARK LAKE LP	CONTRIBUTING EMPLOYER							No
(171) PEAK CAMPUS	CONTRIBUTING EMPLOYER							No
(172) PENINSULA CHICAGO	CONTRIBUTING EMPLOYER							No
(173) PINEAPPLE HOSPITALITY COMPANY	CONTRIBUTING EMPLOYER							No
(174) PONTE GADEA CHICAGO LLC	CONTRIBUTING EMPLOYER							No
(175) PRISA HOTEL LLC	CONTRIBUTING EMPLOYER							No
(176) PROFESSIONAL BUSINESS PROVIDERS INC	CONTRIBUTING EMPLOYER							No
(177) RAINTREE ENTERPRISES 118 INC	CONTRIBUTING EMPLOYER							No
(178) RB-TPG CHICAGO NORTH SHORE LLC	CONTRIBUTING EMPLOYER							No
(179) RENAISSANCE CHICAGO HOTEL	CONTRIBUTING EMPLOYER							No
(180) RITZ-CARLTON HOTEL	CONTRIBUTING EMPLOYER							No
(181) SAGE COLORADO MANAGEMENT	CONTRIBUTING EMPLOYER							No
(182) SIETE 7 LLC	CONTRIBUTING EMPLOYER							No
(183) SODEXO CPS	CONTRIBUTING EMPLOYER							No
(184) SODEXO INC	CONTRIBUTING EMPLOYER							No
(185) SPARTAN CONTRACTORS INC	CONTRIBUTING EMPLOYER							No
(186) STARWOOD LODGING	CONTRIBUTING EMPLOYER							No
(187) STERLING BAY	CONTRIBUTING EMPLOYER							No
(188) STROBECK REAL ESTATE INC	CONTRIBUTING EMPLOYER							No
(189) SUDLER PROPERTY MANAGEMENT	CONTRIBUTING EMPLOYER							No
(190) SWISSOTEL EMPLOYMENT SVCS LLC	CONTRIBUTING EMPLOYER							No
(191) THE BLACKSTONE RENAISSANCE HOTEL	CONTRIBUTING EMPLOYER							No
(192) THE BUCKINGHAM LLC	CONTRIBUTING EMPLOYER							No
(193) THE LANGHAM HOTEL CHICAGO	CONTRIBUTING EMPLOYER							No
(194) THE MERCANTILE PROP MANAGEMENT GROUP LLC	CONTRIBUTING EMPLOYER							No
(195) THE STONE GROUP	CONTRIBUTING EMPLOYER							No
(196) THE WIT	CONTRIBUTING EMPLOYER							No
(197) TIERPOINT ILLINOIS	CONTRIBUTING EMPLOYER							No
(198) TINLEY PARK HOTEL & CONVENTION CENTER LLC	CONTRIBUTING EMPLOYER							No
(199) TISHMAN SPEYER PROPERTIES	CONTRIBUTING EMPLOYER							No
(200) TOWN & COUNTRY UTILITIES INC	CONTRIBUTING EMPLOYER							No
(201) TPG HOSPITALITY	CONTRIBUTING EMPLOYER							No
(202) TRANSWESTERN COMMERCIAL SERVICES	CONTRIBUTING EMPLOYER							No
(203) TWO EAST ERIE CONDOMINIUM ASSOCIATION	CONTRIBUTING EMPLOYER							No
(204) ULTIMA HOSPITALITY LLC	CONTRIBUTING EMPLOYER							No
(205) UNITED CENTER	CONTRIBUTING EMPLOYER							No
(206) UNITED TEMPS INC	CONTRIBUTING EMPLOYER							No
(207) URBAN SERVICES GROUP	CONTRIBUTING EMPLOYER							No
(208) VINAYAKA HOSPITALITY OAKBROOK LLC	CONTRIBUTING EMPLOYER							No
(209) VIRGIN HOTELS CHICAGO	CONTRIBUTING EMPLOYER							No
(210) WABASH ENTERPRISES	CONTRIBUTING EMPLOYER							No
(211) WALDORF-ASTORIA MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(212) WARWICK CHICAGO CORP	CONTRIBUTING EMPLOYER							No
(213) WASHINGTON-FRANKLIN LLC	CONTRIBUTING EMPLOYER							No
(214) WATERTON RESIDENTIAL LLC	CONTRIBUTING EMPLOYER							No
(215) WEST LOOP EQUITIES LLC	CONTRIBUTING EMPLOYER							No
(216) WEST SIDE REALTY CORP	CONTRIBUTING EMPLOYER							No
(217) WESTIN HOTEL MANAGEMENT LP	CONTRIBUTING EMPLOYER							No
(218) WESTSIDE MECHANICAL LLC	CONTRIBUTING EMPLOYER							No
(219) WGM SYSTEMS LLC	CONTRIBUTING EMPLOYER							No
(220) WHITE LODGING SERVICES CORPORATION	CONTRIBUTING EMPLOYER							No
(221) WHITEHALL HOTEL	CONTRIBUTING EMPLOYER							No
(222) WHM REVERE LLC	CONTRIBUTING EMPLOYER							No
(223) WILSON 5 SERVICE COMPANY INC	CONTRIBUTING EMPLOYER							No
(224) WIRTZ REALTY CORP	CONTRIBUTING EMPLOYER							No
(225) WOODLAWN COMM DEV CORP	CONTRIBUTING EMPLOYER							No
(226) YOUNAN PROPERTIES INC	CONTRIBUTING EMPLOYER							No
(227) YTC MANAGEMENT LLC	CONTRIBUTING EMPLOYER							No
(228) ZELLER MANAGEMENT CORPORATION	CONTRIBUTING EMPLOYER							No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: RETIREE-ONLY HEALTH REIMBURSEMENT ACCOUNT PLAN TO HELP DEFRAY THE COST OF HEALTHCARE COVERAGE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	1,194,266	2,024,843
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,092	16,485
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,196,358	2,041,328
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	4,000	38,006
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	34,193	68,922
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	38,193	106,928
19	Revenue less expenses. Subtract line 18 from line 12.......	1,158,165	1,934,400
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,931,381	3,934,142
21	Total liabilities (Part X, line 26).............	17,767	86,128
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,913,614	3,848,014

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	RETIREE-ONLY HEALTH REIMBURSEMENT ARRANGEMENT ACCOUNT PLAN ESTABLISHED FOR THE PURPOSE OF HELPING RETIREES DEFRAY THE COST OF RETIREE HEALTHCARE COVERAGE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(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
(A) Name and title
(1) BRIAN E HICKEY...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	173,919	49,796
(2) VALERIE JO COLVETT...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	142,638	49,846
(3) WILLIAM MASTERSON...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	154,241	49,125
(4) MAUREEN EHREHBERG...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(5) KATHERINE SCOTT...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(6) ERIC CENTAZZO...................................................................... TRUSTEE	1.00 .................	X		0	0	0
(7) CARRIE GATH...................................................................... FUND ADMINISTRATOR	2.50 ................. 42.50		X	0	145,218	41,235

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	616,016	190,002

(A) Name and business address	(B) Description of services	(C) Compensation





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

1a	Federated campaigns..	1a
b	Membership dues..	1b
c	Fundraising events..	1c
d	Related organizations	1d
e	Government grants (contributions)	1e

f	All other contributions, gifts, grants, and similar amounts not included above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	EMPLOYER CONTRIBUTIONS	900099	2,024,843	2,024,843
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		2,024,843

3 Investment income (including dividends, interest, and othersimilar amounts) ......			16,485			16,485
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			2,041,328	2,024,843	0	16,485

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......	38,006
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........	16,575
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	2,505
12	Advertising and promotion ....
13	Office expenses .......	18,798
14	Information technology ......	902
15	Royalties ..
16	Occupancy ...........
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..
23	Insurance ...	328
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	REIMBURSEMENTS FOR SHAR	29,814
b
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	106,928
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		459,665	1	2,404,257
2	Savings and temporary cash investments .........			2
3	Pledges and grants receivable, net ......			3
4	Accounts receivable, net .............		69,624	4	111,308
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				6
7	Notes and loans receivable, net ...........			7
8	Inventories for sale or use ............			8
9	Prepaid expenses and deferred charges ......			9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .		1,402,092	11	1,418,577
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........			15
16	Total assets. Add lines 1 through 15 (must equal line 33)...		1,931,381	16	3,934,142

17	Accounts payable and accrued expenses .....	17,767	17	86,128
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	17,767	26	86,128

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	1,913,614	31	3,848,014
32	Total net assets or fund balances ...........	1,913,614	32	3,848,014
33	Total liabilities and net assets/fund balances ........	1,931,381	33	3,934,142