2023-10-31T14:32:12-05:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 363831874 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN MOSA 4028963884 4980 SOUTH 118TH STREET A OMAHA NE 68137 SCOTT HOFFMAN CHIEF FINANCIAL OFFICER 4028963884 2023-10-30 1 SCOTT HOFFMAN 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2023-10-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SCOTT HOFFMAN 4980 SOUTH 118TH STREET A OMAHA NE 68137 18687966 0 X N/A X 1991 NE TO PROVIDE SELF-FUNDED HEALTH CARE, DENTAL CARE AND EDUCATION COMPENSATION BENEFITS TO PARTICIPANTS WHO ARE ELIGIBLE EMPLOYEES OR TO A COVERED DEPENDENT OF AN ELIGIBLE EMPLOYEE OF MOSAIC AND ITS AFFILIATES. 3 1 0 0 122134 0 0 0 15951429 18472629 271623 -39749 0 0 16223052 18432880 0 0 15615780 14726212 0 0 0 0 0 1796647 1561696 17412427 16287908 -1189375 2144972 7371640 9269524 1592883 1763037 5778757 7506487 TO PROVIDE SELF-FUNDED HEALTH CARE, DENTAL CARE AND EDUCATION COMPENSATION BENEFITS TO PARTICIPANTS WHO ARE ELIGIBLE EMPLOYEES OR TO A COVERED DEPENDENT OF AN ELIGIBLE EMPLOYEE OF MOSAIC AND ITS AFFILIATES. 0 0 COMPREHENSIVE MEDICAL AND DENTAL CARE, EMPLOYEE ASSISTANCE WITH MENTAL AND NERVOUS DISORDERS AND EDUCATION COMPENSATION BENEFITS FOR ELIGIBLE EMPLOYEES AND DEPENDENTS. THERE WERE 2,815 ELIGIBLE EMPLOYEES, OF WHICH 1,417 WERE PARTICIPATING IN THE PLAN DURING THIS CALENDAR YEAR. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 3 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 1 1 1 0 0 0 X SCOTT HOFFMAN 4028963884 4980 S 118TH ST SUITE A OMAHA NE 68137 LINDA TIMMONS CHIEF EXECUTIVE OFFICER 0.10 39.90 X X 0 648851 154241 SCOTT HOFFMAN CHIEF FINANCIAL OFFICER 0.10 39.90 X X 0 373725 66497 GREAT WESTERN BANK TRUSTEE THRU 08/22 0.10 X 0 0 0 SECURITY NATIONAL BANK TRUSTEE AS OF 09/22 0.10 X 0 0 0 0 1022576 220738 0 0 1 0 0 EMPLOYER CONTRIBUTIONS 525100 10528619 10528619 EMPLOYEE CONTRIBUTIONS 525100 7944010 7944010 18472629 122134 122134 93203 255086 -161883 -161883 -161883 18432880 18472629 122134 -161883 14726212 1147950 2500 13262 167035 WELLNESS 153850 LIFE INSURANCE PREMIUMS 77099 16287908 1732216 953082 266791 1265322 228681 397123 5143952 6653997 7371640 9269524 1592883 1763037 1592883 1763037 X 0 0 0 0 5778757 7506487 5778757 7506487 7371640 9269524 2144972 -417242 0 X 0 0 0 0 0 0 LINDA TIMMONS CHIEF EXECUTIVE OFFICER 0 496193 0 148468 0 4190 0 112628 0 41613 0 803092 0 0 SCOTT HOFFMAN CHIEF FINANCIAL OFFICER 0 311970 0 60570 0 1185 0 38974 0 27523 0 440222 0 0 PART I, LINE 3 THE SALARIES OF LINDA TIMMONS AND SCOTT HOFFMAN ARE PAID FROM A RELATED ORGANIZATION, MOSAIC. MS. TIMMONS SERVES AS CEO OF MOSAIC. MR. HOFFMAN SERVES AS CFO OF MOSAIC. THE SALARY FOR MS. TIMMONS IS SET BY THE MOSAIC EXECUTIVE COMMITTEE AND MOSAIC BOARD OF DIRECTORS. MR. HOFFMAN'S SALARY IS SET BY THE CEO OF MOSAIC WORKING WITHIN THE SALARY RANGES ESTABLISHED BY THE EXECUTIVE COMMITTEE. MOSAIC'S BOARD AND COMPENSATION COMMITTEE USE AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND A COMPENSATION SURVEY IN ESTABLISHING THE COMPENSATION OF THE PRESIDENT AND CEO OF MOSAIC AND GUIDELINES FOR OTHER KEY STAFF. SCHEDULE J, PART II, COLUMN C: MOSAIC EVALUATES THE LIABILITY RELATED TO THEIR POSTRETIREMENT BENEFITS (SALARY AND HEALTH INSURANCE CONTINUATION) THROUGH AN ACTUARIAL REVIEW. THE ADJUSTMENT IS INCLUDED IN RETIREMENT AND OTHER DEFERRED COMPENSATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND SUPPORTING SCHEDULES ARE PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FURTHERMORE, THE FORM 990 IS REVIEWED BY THE FINANCE DEPARTMENT OF MOSAIC, A RELATED ENTITY, PRIOR TO SUBMISSION OF THE FORM 990 TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS EACH TRUSTEE COMPLETES A CONFLICT OF INTEREST FORM AND SUBMITS IT TO THE CHAIRPERSON OF THE BOARD INTEGRITY COMMITTEE. ANY FINANCIAL CONFLICTS OF INTEREST ARE REPORTED TO THE CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. ANY NEW CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR ARE REQUIRED TO BE REPORTED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 15 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS, OR EMPLOYEES. THEREFORE, THERE IS NOT A PROCESS IN PLACE FOR DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC GREAT WESTERN BANK - 6015 RADIAL HWY, OMAHA, NE 68104-3425. SECURITY NATIONAL BANK - 1120 S. 101ST STREET, OMAHA, NE 68124. MOSAIC 4980 S 118 STREET OMAHA NE 68137 113669999 SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES NE 501(C)(3) LINE 10 N/A 0 THE MOSAIC FOUNDATION INC 4980 S 118 STREET OMAHA NE 68137 363837360 FUNDRAISING AND INVESTMENT ASSET MANAGEMENT NE 501(C)(3) LINE 12A, I MOSAIC 0 MOSAIC HOUSING CORPORATION I 4980 S 118 STREET OMAHA NE 68137 363756911 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION II 4980 S 118 STREET OMAHA NE 68137 470773689 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION IV 4980 S 118 STREET OMAHA NE 68137 911823422 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION VII 4980 S 118 STREET OMAHA NE 68137 470828015 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION VIII 4980 S 118 STREET OMAHA NE 68137 470828012 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION IX 4980 S 118 STREET OMAHA NE 68137 742838413 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION X 4980 S 118 STREET OMAHA NE 68137 742908789 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XI 4980 S 118 STREET OMAHA NE 68137 311706640 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XII 4980 S 118 STREET OMAHA NE 68137 481297244 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XIII 4980 S 118 STREET OMAHA NE 68137 421626679 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XIV - ROCKFORD 4980 S 118 STREET OMAHA NE 68137 204417891 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XV - COUNCIL BLUFFS 4980 S 118 STREET OMAHA NE 68137 205765691 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XVI - FARMINGTON 4980 S 118 STREET OMAHA NE 68137 205765731 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XVII - BEATRICE 4980 S 118 STREET OMAHA NE 68137 261710013 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XVIII - OSCEOLA-WAUKON 4980 S 118 STREET OMAHA NE 68137 261710184 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XIX - WINFIELD 4980 S 118 STREET OMAHA NE 68137 261710259 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XX - GARDEN CITY 4980 S 118 STREET OMAHA NE 68137 264555206 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XXI - MEMPHIS 4980 S 118 STREET OMAHA NE 68137 264555313 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XXII - LOGAN 4980 S 118 STREET OMAHA NE 68137 273483415 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC HOUSING CORPORATION XXIII - AUSTIN 4980 S 118 STREET OMAHA NE 68137 710875364 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 OAKS OF DUNN COUNTY INC 4980 S 118 STREET OMAHA NE 68137 391913323 SENIOR LIVING SERVICES WI 501(C)(3) LINE 10 MOSAIC 0 MOSAIC ILLINOIS HOUSING I 4980 S 118 STREET OMAHA NE 68137 202997161 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC ILLINOIS HOUSING II 4980 S 118 STREET OMAHA NE 68137 204417645 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC ILLINOIS HOUSING AT MACOMB I 4980 S 118 STREET OMAHA NE 68137 204841909 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC ILLINOIS HOUSING OF ROCKFORD I 4980 S 118 STREET OMAHA NE 68137 204841856 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 0 MOSAIC SENIOR SERVICES INC 4980 S 118 STREET OMAHA NE 68137 831746407 SENIOR LIVING SERVICES AZ 501(C)(3) LINE 12A, I MOSAIC 0 MOSAIC RESIDENTIAL SERVICES OF NEBRASKA LLC 4980 S 118 ST OMAHA NE 68137 271695051 LOW INCOME HOUSING NE N/A 0 0 EASE-E MEDICAL INC 731 SOUTH 8TH STREET CANON CITY CO 81212 470842353 MEDICAL EQUIPMENT/SUPPLIES SALES NE N/A C 0 MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 LOW INCOME HOUSING NE N/A C 0 BICO 4980 S 118 ST OMAHA NE 68137 CAPTIVE INSURANCE BD N/A C 0 CHARITABLE REMAINDER TRUSTS (5) INVESTMENT MANAGEMENT NE N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0