Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART V | PAGE 4, PART V 1C, THIS DOES NOT APPLY. PAGE 5, PART V 3A, DID NOT HAVE ANY UNRELATED INCOME. |
| FORM 990, PART VI | PAGE 6, PART VI 2, THOMAS L SIECK, AGENT IS FATHER OF JEFFREY SIECK, VICE PRESIDENT. PAGE 6, PART VI 2, JOANN SIECK, DIRECTOR IS MOTHER OF JEFFREY SIECK, VICE PRESIDENT. PAGE 6, PART VI 2, THOMAS L SIECK, AGENT IS SPOUSE OF JOANN SIECK, DIRECTOR. PAGE 6, PART VI 6, EACH POLICYHOLDER IS A MEMBER. PAGE 6, PART VI 7A, EACH POLICYHOLDER HAS ONE VOTE. POLICYHOLDER CAN NOMINATE MEMBER TO BOARD OF DIRECTORS AT ANNUAL MEETING. PAGE 6, PART VI 7B, NO, BUT POLICYHOLDERS ARE ADVISED AT ANNUAL MEETING OF ALL DECISIONS. PAGE 6, PART VI 9, NAMES AND ADDRESSES OF ALL INVOLVED ARE PROVIDED IN PART VII, SECTION A, PAGE 7. PAGE 6, PART VI 11B, NO SPECIFIC PROCESS EXCEPT THAT COPIES ARE PROVIDED TO ALL DIRECTORS. PAGE 6, PART VI 19, EACH POLICYHOLDER RECEIVED A POLICY FORM WHICH INCLUDES THE BY-LAWS AND ARTICLES OF INCORPORATION. COPIES OF THE FINANCIAL STATEMENTS ARE DISTRIBUTED TO EACH PERSON WHO ATTENDS THE ANNUAL MEETING. ANNUAL STATEMENTS ARE FILED WITH THE STATE OF NEBRASKA DEPARTMENT OF INSURANCE AND ARE AVAILABLE TO THE PUBLIC. |
| FORM 990, PAGE 6, PART VI, LINE 2 | THOMAS L SIECK JEFFREY SIECK AGENT VP FATHER/SON JOANN SIECK JEFFREY SIECK DIRECTOR VP MOTHER/SON THOMAS L SIECK JOANN SIECK AGENT DIRECTOR SPOUSE |
| FORM 990, PAGE 6, PART VI, LINE 6 | EACH POLICYHOLDER IS A MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 11B | COPIES ARE PROVIDED TO ALL DIRECTORS AND REVIEWED FOR APPROVAL PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | EACH POLICYHOLDER RECEIVED A POLICY FROM WHICH INCLUDES THE BY-LAWS AND ARTICLES OF INCORPORATION. COPIES OF THE FINANCIAL STATEMENT ARE DISTRIBUTED TO EACH PERSON WHO ATTENDS THE ANNUAL MEETING. ANNUAL STATEMENTS ARE FILED WITH THE STATE OF NEBRASKA DEPARTMENT OF INSURANCE AND ARE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART X | PAGE 11, PART X 17, ACCRUED ADJUSTED UNEARNED PREMIUM AND ACCRUED ADJUSTED LOSS OUTSTANDING ADDED. |
| FORM 990, PART XI | PAGE 12, PART XI 8 & 9, ACCRUED ADJUSTED UNEARNED PREMIUM AND ACCRUED ADJUSTED LOSS OUTSTANDING ADDED. |
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