2024-04-23T11:07:06-05:00 2023-12-31 231416352 SAUL EWING LLP 161 N CLARK STREET 4200 CHICAGO IL 60601 990 2023-01-01 386788007 OPTIONS FOR LIVING POOLED CHARITABLE TR OLD NATIONAL WEALTH MGMT CO-TRUSTEE OPTI 6307253315 PO BOX 207 EVANSVILLE IN 477020207 MICHAEL PITTS VICE-PRESIDENT 6307253315 2024-04-23 1 MICHAEL PITTS 999009999 0 THOMAS F MCGUIRE P00035864 3128767100 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z MICHAEL PITTS PO BOX 207 EVANSVILLE IN 47702 848610 0 X N/A X 2000 IL THE TRUST IS A CHARITABLE TRUST WHICH IS THE REMAINDER BENEFICIARY UNDER THE OPTIONS FOR LIVING POOLED OBRA PAY BACK TRUST. WHEN A PARTICIPANT IN THE OBRA POOLED TRUST PASSES AWAY, AND TO THE EXTENT THAT THE PARTICIPANT'S FUND IS NOT FULLY EXHAUSTED BY MEDICAID REIMBURSEMENT AND THE PARTICIPANT DOES NOT DESIGNATE A BENEFICIARY OF THE REMAINING FUNDS, THE FUNDS ARE ADDED TO THE CHARITABLE TRUST TO PROVIDE FUNDS FOR THE CARE OF OTHER PARTICIPANTS IN THE POOLED TRUST AFTER THEIR OWN RESOURCES HAVE BEEN FULLY EXHAUSTED. 2 2 0 0 0 0 0 0 0 0 -108537 98145 50 0 -108487 98145 81346 63360 0 0 0 0 0 0 0 44337 49393 125683 112753 -234170 -14608 2188805 2174197 0 0 2188805 2174197 THE CHARITABLE TRUST PROVIDES FUNDS FOR THE CARE OF PARTICIPANTS IN THE MEDICAID POOLED OBRA TRUST AFTER THEIR OWN RESOURCES HAVE BEEN FULLY EXHAUSTED. 0 0 109163 63360 THE CHARITABLE TRUST MADE DISTRIBUTIONS FOR THE CARE OF INDIVIDUAL BENEFICIARIES OF THE OBRA MEDICAID PAYBACK TRUST WHO EXHAUSTED THEIR OWN SEPARATE ACCOUNTS UNDER THE OBRA TRUST. 109163 1 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 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X OLD NATIONAL WEALTH MGMT 6307253315 520 N CASS AVENUE WESTMONT IL 60559 OLD NATIONAL WEALTH MANAGEMENT CO-TRUSTEE 20.00 X 0 0 0 LIFECARE GUARDIANSHIP INC CO-TRUSTEE 20.00 X 31144 0 0 31144 0 0 0 0 0 0 0 57731 57731 790879 750465 40414 40414 40414 98145 57731 0 40414 X 63360 63360 9436 9436 5208 5208 34734 31144 3590 ILLINOIS CHARITY BUREAU 15 15 112753 109163 3590 0 259098 227423 1929707 1946774 2188805 2174197 0 0 X 2188805 2174197 0 0 0 0 2188805 2174197 2188805 2174197 -14608 0 X 0 0 0 X 0 0 0 1.00000 1.00000 X 1 GRANTS FOR THE HEALTH CARE EXPENSES OF DISABLED BENEFICIARIES OF THE POOLED OBRA TRUST ONCE THEIR SEPARATE ACCOUNT IN EXHAUSTED. 10 63360 PART I, LINE 2: THE ORGANIZATION MAKES GRANTS FROM THE POOLED TRUST FOR THE HEALTH CARE EXPENSES OF BENEFICIARIES OF THE OBRA TRUST ONCE THE BENEFICIARY'S SEPARATE FUNDS UNDER THE POOLED TRUST ARE FULLY EXHAUSTED. FORM 990, PART VI, SECTION B, LINE 11B THE TRUST IS MANAGED BY TWO INDEPENDENT INSTITUTIONAL TRUSTEES. AUTHORIZED REPRESENTATIVES OF EACH CO-TRUSTEE WILL REVIEW THE TAX RETURNS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES OF THE TRUST ARE INSTITUTIONAL TRUSTEES. AS SUCH, THE INTERNAL POLICES OF SUCH INSTITUTIONS GOVERN AND MONITOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE CO-TRUSTEES MAKE COPIES OF GOVERNING DOCUMENTS AND OTHER REQUIRED PUBLIC DISCLOSURES AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G TAX PREPARATION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,590. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,590. CO-TRUSTEE FEES: PROGRAM SERVICE EXPENSES 31,144. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,144.