Adrian Retiree Health Benefits Tr in Fairfield, Connecticut (CT)

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Adrian Retiree Health Benefits Tr
Employer Identification Number (EIN)331196416
Name of OrganizationAdrian Retiree Health Benefits Tr
In Care of NameFki Industries Inc
Address425 Post Road, Fairfield, CT 06824-6232
SubsectionVoluntary Employees' Beneficiary Association (Non-Govt. Emps.)
Ruling Date09/2008
DeductibilityContributions are not deductible
FoundationAll organizations except 501(c)(3)
OrganizationTrust
Exempt Organization StatusUnconditional Exemption
Tax Period12/2012
Assets$5,000,000 to $9,999,999
Income$1,000,000 to $4,999,999
Filing Requirement990 (all other) or 990EZ return
Asset Amount$7,104,354
Amount of Income$1,043,909
Form 990 Revenue Amount$435,126
National Taxonomy of Exempt Entities (NTEE)Mutual/Membership Benefit Organizations, Other: Insurance Providers, Services


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Amount of income in 2012: $1,043,909 (it was $-1,510,300 in 2011)
This organization: 

 $1,043,909
Other organizations performing similar types of work: 

 $508,960

Assets in 2012: $7,104,354 (it was $7,643,941 in 2011)
Adrian Retiree Health Benefits Tr: 

 $7,104,354
Other organizations performing similar types of work: 

 $662,652

Financial snapshot ($)

Statements Regarding Other IRS Filings and Tax Compliance (for 2011)
Did the organization have unrelated business gross income of $1,000 or more during the year?No
Initiation fees and capital contributions$0
Gross receipts for public use of club facilities $0
Gross income from members or shareholders$0
Gross income from other sources$0
Statement of Revenue (for 2011)
Total revenue$-1,510,300
Contributions, Gifts, Grants and Other Similar Amounts$86,259
Program Service Revenue$0
Other Revenue
Investment income (including dividends, interest, and other similar amounts)$1,127,925
Income from investment of tax-exempt bond proceeds$0
Royalties$0
Net rental income$0
Net loss from sales of assets other than inventory$-2,724,484
Gross amount from sales of assets other than inventory (Securities / Other)$0 / $0
Less: cost or other basis and sales expenses (Securities / Other)$2,724,484 / $0
Gain or (loss) (Securities / Other)$-2,724,484 / $0
Net income from fundraising events$0
Net income from gaming activities$0
Net income from sales of inventory$0
Miscellaneous Revenue$0
Statement of Functional Expenses (for 2011)
Total functional expenses$1,089,588
Compensation of current officers, directors, trustees, and key employees$0
Other salaries and wages$0
Payroll taxes$0
Professional fundraising services$0
Other$1,089,588
Balance Sheet (for 2011)
Total assets$7,643,941
Total liabilities$1,875
Tax-exempt bond liabilities$0
Secured mortgages and notes payable to unrelated third parties$0
Unsecured notes and loans payable to unrelated third parties$0
Other$1,875
Total net assets or fund balances$7,642,066
Retained earnings, endowment, accumulated income, or other funds$0
Reason for Public Charity Status (for 2011)
The organization is not a private foundation because it is:Not provided
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1Delta Dental Of Pennsylvania, Pennsylvania Dental Service Corp1 Delta Dr, Mechanicsburg, PA 17055-6999PA1967-07$568,680,154
2Delta Dental Of New York Inc1 Delta Dr, Mechanicsburg, PA 17055-6999PA1969-06$328,317,206
3Sutter Insurance Services Corporation745 Fort Street, Honolulu, HI 96813-3800HI1993-05$245,249,291
4New York Trades Council & Hotel Association Of New York City, Health Center Inc305 W 44th St, New York, NY 10036-5402NY2011-03$98,820,187
5Ufcw Local One Health Care Fund, 15911 Airport Rd, Oriskany, NY 13424-3904NY1961-03$72,956,405
6United Church Insurance Company Inc700 Prospect Ave E, Cleveland, OH 44115-1110OH2004-01$18,057,502
7Hospital Sisters Health System Self Insurance Trust Fund4936 Laverna Rd, Springfield, IL 62707-9797IL1985-01$11,463,931
8Meritcare Health Enterprises IncPO BOX 2010, Fargo, ND 58122-0408ND1999-12$6,960,882
9Associated Health Assurance Ltd3300 Oakdale Ave N, Robbinsdale, MN 55422-2926MN2001-04$3,999,326
10Missouri Health Insurance PoolPO BOX 104538, Jefferson Cty, MO 65110-4538MO2004-06$72,895,936
11Fidelity Welfare Benefit Plans Veba Trust82 Devonshire Street V6d, Boston, MA 02109-3605MA2009-03$70,011,612
12Clara Abbott Foundation, The Northern Tr Co1505 S White Oak Dr, Waukegan, IL 60085-8303IL1999-12$69,163,396
13Komatsu America Corp Retiree Welfare Noncollectively BargainedPO BOX 85292, San Diego, CA 92186-5292CA2009-09$45,193,593
14Alliance Of Nonprofits For Insurance Risk Retention Group IncPO BOX 8507, Santa Cruz, CA 95061-8507CA2000-12$25,353,049
15Mrm Property And Liability Tr Inc2591 Wexford Bayne Rd Ste 301, Sewickley, PA 15143-8676PA2004-11$19,890,789
16American United Life Insurance Company Welfare Benefits TrustPO BOX 368, Indianapolis, IN 46206-0368IN2009-07$17,960,257
17Northpark Village CorporationOne Financial Plaza Ste 1700, Hartford, CT 06103-2608CT2005-02$3,058,858
18Adrian Retiree Health Benefits Tr425 Post Road, Fairfield, CT 06824-6232CT2008-09$1,043,909
19Greenwich Leadership Forum IncPO BOX 1517, Greenwich, CT 06836-1517CT2005-02$185,269
20Naugatuck Baseball League Inc272 Park Ave, Naugatuck, CT 06770-2623CT2001-05$28,129
Number of organizations performing similar types of work
Alabama3
Arkansas2
Arizona11
California23
Colorado1
Connecticut7
District of Columbia2
Florida8
Georgia6
Hawaii4
Idaho4
Illinois12
Indiana5
Kansas1
Kentucky6
Louisiana4
Massachusetts2
Maryland2
Maine1
Michigan5
Minnesota14
Missouri5
Montana1
North Carolina6
North Dakota2
Nebraska2
New Hampshire1
New Jersey1
New Mexico3
Nevada4
New York9
Ohio6
Oklahoma4
Oregon3
Pennsylvania13
Rhode Island1
South Carolina3
Tennessee5
Texas10
Utah1
Virginia4
Vermont2
Washington5
Wisconsin6
International5
Total225

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