TY 2019 Form 990

(A)
Name and title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(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

(1) RALPH CHIPMAN......................................................................
Trustee

0.10
.................
0.00

(2) JEFF HERRO......................................................................
Trustee

1.00
.................
0.00

(A)
Name and title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(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 business address

(B)
Description of services

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

- 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

NEW BERLIN RETIREE HEALTH CARE SUBSIDY
PLAN AND TRUST

Employer identification number

39-1860172

Return Reference	Explanation
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents	THE ORGANIZATION UPDATED THE ARTICLES OF THE TRUST AND THE CONTRACT TO ALLOW OFFICERS WHO LEAVE THE POLICE DEPARTMENT PRIOR TO BEING ELIGIBLE FOR RETIREMENT CURRENTLY AGE 50 WITH 20 YEARS OF SERVICE AT THE NEW BERLIN POLICE DEPARTMENT.IN SUCH CASES, THE PARTICIPANT IS REQUIRED TO REMIT A TRUST FEE BACK TO THE ORGANIZATION TO REMAIN ELIGIBLE FOR THE TRUST.
Form 990, Part VI, Line 9: Officer, Director, Trustee, Key Employee Mailing Address	RALPH CHIPMAN- (City of New Berlin Treasurer)- 3805 S. CASPER DR, NEW BERLIN, WI 53151
Form 990, Part VI, Line 11b: Form 990 Review Process	THE FINAL FORM 990 IS REVIEWED WITH THE TRUSTEE PRIOR TO FILING THE TAX RETURN WITH THE IRS. DURING THIS REVIEW, THE ANNUAL INCOME AND EXPENSES REPORTED ON THE TAX RETURN ARE REVIEWED WITH THE TRUSTEE AS WELL AS THE APPLICABLE YES/NO QUESTIONS.A SIGNED COPY OF THE TAX RETURN IS PROVIDED TO THE TRUSTEE IMMEDIATELY UPON COMPLETION BY THE TAX PREPARER AND A COPY OF THE TAX RETURN IS PROVIDED TO THE BOARD FOR A SUBSEQUENT REVIEW AND THEN PLACED IN THEIR PERMANENT FILE FOR PUBLIC INSPECTION.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	PERIODIC GROUP MEETINGS AND INDIVIDUAL DIRECT AND INDIRECT ASSESSMENTS.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	THE ORGANIZATION DOES MAKE AVAILABLE ITS GOVERNING DOCUMENTS, FORM 990, AND ORIGINAL TAX DETERMINATION LETTER/EXEMPTION APPLICATION FORM, TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE A WEBSITE TO POST THESE ITEMS, BUT THERE IS A FILE AT THE ORGANIZATIONS OFFICE WITH THESE ITEMS IN IT, AVAILABLE FOR PUBLIC INSPECTION, BY APPOINTMENT.
PART XII	FINANCIAL STATEMENTS ARE PREPARED BY AN OUTSIDE ACCOUNTANT AND THEY HAVE NOT BEEN SUBJECTED TO AN AUDIT OR REVIEW OR COMPILATION ENGAGEMENT, AND NO ASSURANCE IS PROVIDED ON THEM.

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:	19009920
Software Version:	2019v5.0

1	Briefly describe the organization’s mission or most significant activities: THE TRUST WILL MAINTAIN AND INVEST PRINCIPAL,ACCUMULATE ASSETS AND MAKE DISTRIBUTIONS ON BEHALF OF PARTICIPANTS IN THE FORM OF SUBSIDIES TOWARD THEIR RETIREE HEALTH CARE. PARTICIPANTS ARE RETIRED POLICE OFFICERS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	3
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	5
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........	80,038	81,238
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	46,428	55,915
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		3,000
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	126,466	140,153
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	50,700	47,450
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,607	12,144
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	62,307	59,594
19	Revenue less expenses. Subtract line 18 from line 12.......	64,159	80,559
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,020,367	1,272,812
21	Total liabilities (Part X, line 26).............		0
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,020,367	1,272,812

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	ON A MONTHLY BASIS, THE TRUST SUBSIDIZES MONTHLY RETIREE HEALTH BENEFITS.DURING 2019 THERE WERE 68 PARTICIPANTS, 17 OF WHICH RECEIVED SUBSIDY BENEFIT PAYMENTS.

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

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

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




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.......		0

		Business Code
2a	CITY OF NEW BERLIN	525100	81,238	81,238
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		81,238

3 Investment income (including dividends, interest, and othersimilar amounts) ......			30,636	30,636
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(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).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	9,856	570,010	7a
b	Less: cost or other basis and sales expenses		554,587	7b
c	Gain or (loss)	9,856	15,423	7c
d	Net gain or (loss).........			25,279	25,279
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..			0
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..			0
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..			0
Business Code			Miscellaneous Revenue
11a	BENEFIT REIMB FEE		525100	3,000	3,000
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			3,000
12	Total revenue. See instructions.....			140,153	140,153

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	47,450	47,450
5	Compensation of current officers, directors, trustees, and key employees ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	10,899	10,899
b	Legal .........	0
c	Accounting ...........	1,020		1,020
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	0
12	Advertising and promotion ....	0
13	Office expenses .......	0
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	0
17	Travel ............	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	0
23	Insurance ...	0
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	FOREIGN TAXES WITHHELD	225	225
b
c
d
e	All other expenses	0
25	Total functional expenses. Add lines 1 through 24e	59,594	58,574	1,020	0
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 ........			1	0
2	Savings and temporary cash investments .........		10,044	2	11,342
3	Pledges and grants receivable, net ......			3	0
4	Accounts receivable, net .............			4	0
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	0
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	0
7	Notes and loans receivable, net ...........			7	0
8	Inventories for sale or use ............			8	0
9	Prepaid expenses and deferred charges ......			9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c	0
11	Investments—publicly traded securities .		1,010,322	11	1,261,470
12	Investments—other securities. See Part IV, line 11 .....			12	0
13	Investments—program-related. See Part IV, line 11 ..			13	0
14	Intangible assets ...............			14	0
15	Other assets. See Part IV, line 11 ...........		1	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...		1,020,367	16	1,272,812

17	Accounts payable and accrued expenses .....		17
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..	0	26	0

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,020,367	27	1,272,812
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 .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	1,020,367	32	1,272,812
33	Total liabilities and net assets/fund balances ........	1,020,367	33	1,272,812