TY 2022 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

2021

Open to Public Inspection

Name of the organization

Lakeland Post-Retirement Medical Trust

Employer identification number

46-2332843

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) 2021

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).)..

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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) 2021

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	-1,816,728
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-2,911,916
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	759,984
e	Add lines 2a through 2d .....................			2e	-2,151,932
3	Subtract line 2e from line 1..................			3	335,204
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	0
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	335,204

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	839,280
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	759,984
e	Add lines 2a through 2d....................			2e	759,984
3	Subtract line 2e from line 1...................			3	79,296
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	0
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	79,296

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
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	EMPLOYER CONTRIBUTIONS - 759984
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	CLAIMS PAID - 759984

Schedule D (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- 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

2022

Open to Public Inspection

Name of the organization

Lakeland Post-Retirement Medical Trust

Employer identification number

46-2332843

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? .............

Yes

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

Yes

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) 2022

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1PAUL KONOPACKI TRUSTEE	(i) (ii)	0 ------------- 316,985	0 ------------- 109,732	0 ------------- 35,980	0 ------------- 94,643	0 ------------- 60,032	0 ------------- 617,372	0 ------------- 35,248
2NORMA TIRADO-KELLENBERGER TRUSTEE	(i) (ii)	0 ------------- 243,447	0 ------------- 105,181	0 ------------- 118,198	0 ------------- 46,475	0 ------------- 56,231	0 ------------- 569,532	0 ------------- 46,308

Schedule J (Form 990) 2022

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, Part I, Line 4a Severance or change-of-control payment	DURING 2022 THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM A RELATED ORGANIZATION: NORMA TIRADO-KELLENBERGER - $68,257
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	SCHEDULE J, PART I, LINE 4B IS ANSWERED YES BECAUSE CERTAIN INDIVIDUALS, DO PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S) FOR A RELATED ORGANIZATION. SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR WHILE ALSO BEING REPORTED IN THE CURRENT 990 AS TOTAL COMPENSATION. THE NONQUALIFIED RETIREMENT PLANS ARE AN INDUSTRY STANDARD AND ARE SUBJECT TO THE FUNDING REQUIREMENTS OF NONQUALIFIED DEFERRED COMPENSATION PLANS UNDER ERISA AND FEDERAL TAX REGULATIONS. DISTRIBUTIONS PAID BY A RELATED ORGANIZATION ARE AS FOLLOWS: NORMA TIRADO-KELLENBERGER - $46,308 PAUL KONOPACKI - $35,248

Return Reference

Explanation

Schedule J, Part I, Line 4a Severance or change-of-control payment

DURING 2022 THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM A RELATED ORGANIZATION: NORMA TIRADO-KELLENBERGER - $68,257

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan

SCHEDULE J, PART I, LINE 4B IS ANSWERED YES BECAUSE CERTAIN INDIVIDUALS, DO PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S) FOR A RELATED ORGANIZATION. SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR WHILE ALSO BEING REPORTED IN THE CURRENT 990 AS TOTAL COMPENSATION. THE NONQUALIFIED RETIREMENT PLANS ARE AN INDUSTRY STANDARD AND ARE SUBJECT TO THE FUNDING REQUIREMENTS OF NONQUALIFIED DEFERRED COMPENSATION PLANS UNDER ERISA AND FEDERAL TAX REGULATIONS. DISTRIBUTIONS PAID BY A RELATED ORGANIZATION ARE AS FOLLOWS: NORMA TIRADO-KELLENBERGER - $46,308 PAUL KONOPACKI - $35,248

Schedule J (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

Lakeland Post-Retirement Medical Trust

Employer identification number

46-2332843

Return Reference	Explanation
Form 990, Part VI, Line 12b	THE TRUST AGREEMENT GOVERNS THE ACTIVITY OF THE TRUST AND A WRITTEN CONFLICT OF INTEREST POLICY IS NOT DEEMED NECESSARY.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing body	THE TRUST DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
Form 990, Part VI, Line 19 Required documents available to the public	GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
Form 990, Part IX, Line 11g Other Fees	ACTUARY - Total Expense: 31030, Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ;

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- 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

2021

Open to Public Inspection

Name of the organization

Lakeland Post-Retirement Medical Trust

Employer identification number

46-2332843

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)COREWELL HEALTH 100 MICHIGAN ST NE MC 498 GRAND RAPIDS,MI49503 38-3382353	MANAGEMENT	MI	501(c)(3)	Type III-FI	NA		No
(2)SPECTRUM HEALTH HOSPITALS 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 38-1360529	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(3)SPECTRUM HEALTH PRIMARY CARE PARTNERS 1840 WEALTHY ST SE GRAND RAPIDS,MI49506 38-1358164	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(4)COREWELL HEALTH FOUNDATION WEST MICHIGAN 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 38-2752328	PHILANTHROPY	MI	501(c)(3)	7	COREWELL HEALTH		No
(5)SPECTRUM HEALTH CONTINUING CARE 750 FULLER AVE NE GRAND RAPIDS,MI49503 38-3242232	REHAB/CARE	MI	501(c)(3)	10	COREWELL HEALTH		No
(6)SPECTRUM HEALTH CONTINUING CARE CENTER 750 FULLER AVE NE GRAND RAPIDS,MI49503 38-2415333	REHAB/NRS	MI	501(c)(3)	10	SPECTRUM HEALTH CONTINUING CARE		No
(7)SPECTRUM HEALTH WORTH SERVICES 750 FULLER AVE NE GRAND RAPIDS,MI49503 38-2786617	HEALTHCARE	MI	501(c)(3)	10	SPECTRUM HEALTH CONTINUING CARE		No
(8)VISITING NURSE SERVICES OF WESTERN MICHIGAN 750 FULLER AVE NE GRAND RAPIDS,MI49503 38-1359195	HEALTHCARE	MI	501(c)(3)	10	SPECTRUM HEALTH CONTINUING CARE		No
(9)SPECTRUM HEALTH - LEFFINGWELL AVENUE 100 MICHIGAN STREET NE GRAND RAPIDS,MI49503 85-4390483	REHAB/CARE	MI	501(c)(3)	10	SPECTRUM HEALTH CONTINUING CARE		No
(10)PRIORITY HEALTH 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 38-2715520	HMO	MI	501(c)(4)		COREWELL HEALTH		No
(11)TRINITY HEALTH PLANS 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 38-2663747	HMO MGMT	MI	501(c)(4)		PRIORITY HEALTH		No
(12)PRIORITY HEALTH CHOICE INC 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 32-0016523	HMO (MEDICAID)	MI	501(c)(3)	10	PRIORITY HEALTH		No
(13)SPECTRUM HEALTH KELSEY 615 S BOWER GREENVILLE,MI48838 38-1297435	HEALTHCARE	MI	501(c)(3)	3	SPECTRUM HEALTH UNITED		No
(14)REED CITY HOSPITAL CORPORATION 300 N PATTERSON RD REED CITY,MI49677 38-2770076	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(15)NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION 212 S SULLIVAN AVENUE FREMONT,MI49412 38-1359517	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(16)KENT COMMUNITY HEALTH FOUNDATION 750 FULLER AVE NE GRAND RAPIDS,MI49503 38-3607110	PHILANTHROPY	MI	501(c)(3)	Type III-O	SPECTRUM HEALTH HOSPITALS		No
(17)ZEELAND COMMUNITY HOSPITAL 8333 FELCH STREET ZEELAND,MI49464 38-1411184	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(18)SPECTRUM HEALTH UNITED 615 S BOWER GREENVILLE,MI48838 38-1358412	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(19)MEMORIAL MEDICAL CENTER OF WEST MICHIGAN ONE ATKINSON DRIVE LUDINGTON,MI49431 38-1359266	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(20)MECOSTA COUNTY MEDICAL CENTER 605 OAK STREET BIG RAPIDS,MI49307 38-1368744	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(21)PENNOCK HOSPITAL 1009 WEST GREEN STREET HASTINGS,MI49058 38-1360562	HEALTHCARE	MI	501(c)(3)	3	COREWELL HEALTH		No
(22)LAKESHORE AREA RADIATION ONCOLOGY CENTER 12642 Riley Street Holland,MI494249202 38-3067954	Radiation services	MI	501(c)(3)	3	Spectrum Health Hospitals		No
(23)LAKELAND REGIONAL HEALTH SYSTEM INC 1234 NAPIER AVENUE ST JOSEPH,MI49085 38-2609624	PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITY	MI	501(c)(3)	Type III-FI	COREWELL HEALTH		No
(24)LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER 1234 NAPIER AVENUE STJOSEPH,MI49085 38-3452303	LONGTERM HEALTHCARE/HEALING SERVICES	MI	501(c)(3)	3	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(25)LAKELAND HEALTH FOUNDATION BENTON HARBORST JOSEPH 1234 NAPIER AVENUE ST JOSEPH,MI49085 38-2539929	PROMOTE AND ASSIST IN PROVIDING HEALTH CARE	MI	501(c)(3)	7	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(26)MERCY MEMORIAL HEALTH SERVICES INC 4368 CLEVELAND AVENUE STEVENSVILLE,MI49127 38-2748035	PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN SOUTHWEST MICHIGAN	MI	501(c)(3)	10	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(27)LAKELAND COMMUNITY HOSPITAL - WATERVLIET 400 MEDICAL PARK DRIVE WATERVLIET,MI49098 38-1368745	TO PROVIDE GENERAL HEALTH OF THE COMMUNITY THROUGH EDUCATION AND HEALTHCARE	MI	501(c)(3)	3	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(28)HOSPICE AT HOME INC 4025 HEALTH PARK LANE ST JOSEPH,MI49085 38-2416086	TO PROVIDE HOSPICE AND PALLIATIVE CARE TO THE TERMINALLY ILL	MI	501(c)(3)	7	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(29)LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVENUE GRAND RAPIDS,MI49085 38-2156872	PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITY	MI	501(c)(3)	3	LAKELAND REGIONAL HEALTH SYSTEM INC		No
(30)TOTAL HEALTH CARE INC 3011 W GRAND BLVD SUITE 1600 DETROIT,MI48202 38-2018957	HMO MGMT	MI	501(c)(4)		PRIORITY HEALTH		No
(31)TOTAL HEALTH CARE USA INC 3011 W GRAND BLVD SUITE 1600 DETROIT,MI48202 38-3240485	HMO MGMT	MI	501(c)(4)		TOTAL HEALTH CARE INC		No
(32)BEAUMONT HEALTH 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 46-5718220	MANAGEMENT	MI	501(c)(3)	Type III-FI	COREWELL HEALTH		No
(33)BOSTFORD CONTINUING CARE CORPORATION 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2549505	LONG TERM NURSING CARE	MI	501(c)(3)	10	BOTSFORD GENERAL HOSPITAL		No
(34)BH GRAND RIVER SOUTHFIELD INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2410823	EMERGENCY MEDICAL SERVICES	MI	501(c)(3)	10	BOTSFORD GENERAL HOSPITAL		No
(35)MICHIGAN MOBILE PET IMAGING 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 33-1086165	MOBILE PET SCANNING	MI	501(c)(3)	Type I	OAKWOOD HEALTHCARE INC		No
(36)OAKWOOD HEALTHCARE INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-1405141	HOSPITAL	MI	501(c)(3)	3	BEAUMONT HEALTH		No
(37)OAKWOOD UNITED HOSPITALS INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2837961	FACILITY LEASING	MI	501(c)(3)	Type I	OAKWOOD HEALTHCARE INC		No
(38)OAKWOOD HOME CARE SERVICES 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2877338	HOME HEALTH SERVICES	MI	501(c)(3)	10	OAKWOOD HEALTHCARE INC		No
(39)WILLIAM BEAMONT HOSPITAL 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-1459362	HOSPITAL	MI	501(c)(3)	3	BEAUMONT HEALTH		No
(40)BEAUMONT HEALTH FOUNDATION 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 36-4852171	FOUNDATION	MI	501(c)(3)	7	BEAUMONT HEALTH		No
(41)BEAUMONT MEDICAL GROUP - HOSPITAL BASED 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 82-2768899	PHYSICIAN SUPPORT SERVICES	MI	501(c)(3)	10	BEAUMONT HEALTH		No
(42)BEAUMONT MEDICAL GROUP - SPECIALTY SERVICES 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 82-2784244	PHYSICIAN SUPPORT SERVICES	MI	501(c)(3)	10	BEAUMONT HEALTH		No
(43)BEAUMONT MEDICAL GROUP - PRIMARY CARE SERVICES 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 82-2796539	PHYSICIAN SUPPORT SERVICES	MI	501(c)(3)	10	BEAUMONT HEALTH		No
(44)BOSTFORD GENERAL HOSPITAL 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-1426919	HOSPITAL	MI	501(c)(3)	3	BEAUMONT HEALTH		No
(45)BEAUMONT MEDICAL TRANSPORTATION SERVICE 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 26-0203703	MEDICAL TRANSPORTATION SERVICES	MI	501(c)(3)	10	BH GRAND RIVER SOUTHFIELD INC		No
(46)OAKWOOD HEALTH PROMOTIONS INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2601965	ASSISTED AND RESIDENT CARE FACILITIES	MI	501(c)(3)	10	OAKWOOD HEALTH CARE INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) WEST MICHIGAN ACCOUNTABLE CARE ORGANIZATION LLC 221 MICHIGAN ST NE STE 501 GRAND RAPIDS,MI49503 83-3153113	ACCOUNTABLE CARE ORGANIZATION	MI	NA	N/A				No			No
(2) DEARBORN SCHAEFFER OFFICE COMPANY LLC 26901 BEAUMONT BOULEVARD SOUTHFIELD,MI48033 26-2448025	REAL ESTATE	MI	NA	N/A				No			No
(3) OAKMED LLC 1938 WOODSLEE DRIVE TROY,MI48033 46-1459737	PRIVATE DUTY NURSING	MI	NA	N/A				No			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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) PRIORITY HEALTH MANAGED BENEFITS 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 38-3085182	THIRD PARTY ADMINISTRATOR	MI	NA	C Corporation					No
(2) SPECTRUM HEALTH PHYSICIAN ALLIANCE 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 37-1655728	PHYSICIANS	MI	NA	C Corporation					No
(3) WEST MICHIGAN HEART 2900 BRADFORD STREET NE GRAND RAPIDS,MI49525 38-2125186	PHYSICIANS	MI	NA	C Corporation					No
(4) HELEN DEVOS WOMEN'S AND CHILDREN'S HEALTH PAVILION ASSOCIATION 330 BARCLAY NE GRAND RAPIDS,MI49503 38-3264184	MGMT	MI	NA	C Corporation					No
(5) LEMMEN-HOLTON CANCER PAVILION CONDOMINIUM ASSOCIATION 145 MICHIGAN ST NE GRAND RAPIDS,MI49503 16-1734150	MGMT	MI	NA	C Corporation					No
(6) MUSCULOSKELETAL CENTER CONDOMINIUM ASSOCIATION 230 MICHIGAN NE GRAND RAPIDS,MI49503 38-3180086	MGMT	MI	NA	C Corporation					No
(7) PRIORITY HEALTH INSURANCE COMPANY 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 20-1529553	INSURANCE	MI	NA	C Corporation					No
(8) THE MICHIGAN STREET PARKING CONDOMINIUM ASSOCATION 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 16-1734145	MGMT	MI	NA	C Corporation					No
(9) 25 MICHIGAN STREET CONDOMINIUM ASSOCIATION 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 16-1734157	MGMT	MI	NA	C Corporation					No
(10) 35 MICHIGAN STREET CONDOMINIUM ASSOCIATION 35 MICHIGAN ST NE GRAND RAPIDS,MI49503 27-2193084	MGMT	MI	NA	C Corporation					No
(11) PENNOCK VENTURES INC 1009 WEST GREEN STREET HASTINGS,MI49058 38-2712819	Healthcare	MI	NA	C Corporation					No
(12) LAKELAND HEALTH ENTERPRISES INC 31 NORTH ST JOSEPH AVENUE NILES,MI49120 38-2669798	ACCOUNTING AND BILLING	MI	NA	C Corporation					No
(13) PHARMACY SHOPPE INC 1234 NAPIER AVENUE ST JOSEPH,MI49085 38-2929090	PHARMACEUTICALS	MI	NA	C Corporation					No
(14) LAKELAND MEDICAL PRACTICES 1234 NAPIER AVENUE STJOSEPH,MI49085 27-0381199	MEDICAL ADMINISTRATIVE SERVICES	MI	NA	C Corporation					No
(15) SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 NAPIER AVENUE ST JOSEPH,MI49085 27-2589359	PHYSICIAN OFFICE	MI	NA	C Corporation					No
(16) FOUR FLAGS PROPERTIES INC 122 GRANT STREET NILES,MI49120 36-4501639	PROPERTY MANAGEMENT/RENTAL	MI	NA	C Corporation					No
(17) LAKELAND HEALTH VENTURES INC 1234 NAPIER AVENUE ST JOSEPH,MI49085 27-2313790	HOLDING COMPANY	MI	NA	C Corporation					No
(18) LAKELAND PHYSICIAN CARE NETWORK 1234 NAPIER AVENUE ST JOSEPH,MI49085 20-8513031	MEDICAL SERVICES	MI	NA	C Corporation					No
(19) LAKELAND PERSONAL CARE SERVICES INC 1234 NAPIER AVENUE ST JOSEPH,MI49085 27-2990797	HEALTHCARE SERVICES	MI	NA	C Corporation					No
(20) 1697 MICHIGAN STREET PROPERTY 100 MICHIGAN STREET NE GRAND RAPIDS,MI49503 83-1721239	MGMT	MI	NA	C Corporation					No
(21) BLUE STAR PROFESSIONAL BUILDING CONDO ASSOCIATION 4025 HEALTH PARK LANE ST JOSEPH,MI49085 20-8313519	MGMT	MI	NA	C Corporation					No
(22) PHMB CAMADS TRUST 1231 EAST BELTLINE NE GRAND RAPIDS,MI49525 84-6496888	TRUST	MI	NA	Trust					No
(23) PENNOCK PROFESSIONAL BUILDING CONDOMINIUM ASSOCIATION 1009 WEST GREEN STREET HASTINGS,MI49058 38-4056359	MGMT	MI	NA	C Corporation					No
(24) COREWELL HEALTH INDEMNITY COMPANY 98-0512415	PREMIUM DEPOSITS	CJ	NA	C Corporation					No
(25) BEAUMONT NURSING HOME SERVICES INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2799842	ASSISTED CARE LIVING	MI	NA	C Corporation					No
(26) BEAUMONT PHYSICIANS INSURANCE COMPANY INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 27-4261262	PROFESSIONAL INSURANCE	MI	NA	C Corporation					No
(27) BOTSFORD COMMONS PROPERTY ASSOCIATION 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-3203663	PROPERTY MANAGEMENT	MI	NA	C Corporation					No
(28) OAKWOOD AFFILIATED VENTURES INC AND SUBSIDIARIES 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 37-1753159	OFFICE OF PHYSICIANS / NON-RESIDENTIAL RENTAL	MI	NA	C Corporation					No
(29) BH SOUTHFIELD BILLING INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2755982	MANAGEMENT AND DISPATCH SERVICES	MI	NA	C Corporation					No
(30) MIDWEST MEDICAL CENTER 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 26-3683446	OFFICE OF PHYSICIANS	MI	NA	C Corporation					No
(31) OAKWOOD ENTERPRISES INC 26901 BEAUMONT BLVD SOUTHFIELD,MI48033 38-2601930	NON RESIDENTIAL RENTAL	MI	NA	C Corporation					No
(32) MICHIGAN STREET PROJECT CONDOMINIUM ASSOCIATION 100 MICHIGAN ST NE GRAND RAPIDS,MI49503 36-4873152	MGMT	MI	NA	C Corporation					No
(33) GRAND RIVER ABSOLUTE RETURN FUND LTD PO BOX 852 GRAND CAYMANKY11103 CJ	POOLED INVESTMENT FUND	CJ	COREWELL HEALTH						No

Schedule R (Form 990) 2021

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) ......................

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) ...................

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

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

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

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

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

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) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

1	Briefly describe the organization’s mission or most significant activities: THE TRUST WAS ESTABLISHED TO FUND THE POSTRETIREMENT OBLIGATION OF LAKELAND REGIONAL HEALTH SYSTEM, INC.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	2
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2021 (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, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........		0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	317,339	335,204
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	317,339	335,204
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).....		0
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)....	85,761	79,296
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	85,761	79,296
19	Revenue less expenses. Subtract line 18 from line 12.......	231,578	255,908
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	18,539,802	15,883,794
21	Total liabilities (Part X, line 26).............	0	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	18,539,802	15,883,794

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	PAYMENT OF STIPEND TO ELIGIBLE RETIREES TOWARDS THE PURCHASE OF HEALTH INSURANCE OR TO PURCHASE THEIR OWN MEDICARE STOP LOSS INSURANCE COVERAGE. NUMBER OF ACTIVE MEMBERS IN THE PLAN IS 440. TOTAL EMPLOYEES THAT COULD BECOME ELIGIBLE TO RECEIVE FUTIRE BENEFITS UPON RETIREMENT IS 547.

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 expenses0

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) NORMA TIRADO-KELLENBERGER TRUSTEE	1.0 ................. 50.0	X	0	466,826	102,706
(2) PAUL KONOPACKI TRUSTEE	1.0 ................. 50.0	X	0	462,697	154,675

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	929,523	257,381

(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.......		0

		Business Code
2a
b
c
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		0

3 Investment income (including dividends, interest, and othersimilar amounts) ......			331,023			331,023
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)	0	0	6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		437,330	7a
b	Less: cost or other basis and sales expenses		433,149	7b
c	Gain or (loss)	0	4,181	7c
d	Net gain or (loss).........			4,181			4,181
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 ....			0	0	0	0
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			335,204	0	0	335,204

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 .......
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 ...........	31,100
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	17,166
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	31,030
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
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 ...
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
b
c
d
e	All other expenses	0
25	Total functional expenses. Add lines 1 through 24e	79,296
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 ........			1,753,485	1	2,228,159
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............				4
5	Loans and other receivables from 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
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	0
b	Less: accumulated depreciation	10b	0		10c	0
11	Investments—publicly traded securities .			16,786,317	11	13,655,635
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			18,539,802	16	15,883,794

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	0
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	0	25	0
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 ..........		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 .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds	18,539,802	31	15,883,794
32	Total net assets or fund balances ...........	18,539,802	32	15,883,794
33	Total liabilities and net assets/fund balances ........	18,539,802	33	15,883,794