2022-07-27T14:07:49-05:00 2021-12-31 421104473 MHCS PC 1601 W LAKES PKWY STE 300 WEST DES MOINES IA 50266 990 2021-01-01 852370921 UNITYPOINT RURAL HEALTH ALLIANCE BENEFITS TRUST UNIT 5152416161 1776 WEST LAKES PKWY STE 400 WEST DES MOINES IA 50266 MICHELLE SLEITER TRUSTEE TREASURER 7123355224 2022-07-22 true MICHELLE SLEITER 999009999 ALEXANDRA KAFER CPA P02066016 5152883279 2022-07-26 2021 2022-09-23 18:48:47Z JAMES ROETMAN 21953031 false X X 2020 IA TO PROVIDE FOR THE PAYMENT OF LIFE, SICK, ACCIDENT AND OTHER PERMISSIBLE BENEFITS OFFERED UNDER THE PLAN TO THE PARTICIPATING EMPLOYEES AND OTHER PARTICIPANTS THROUGH INSURANCE AND OTHER QUALIFYING BENEFITS. 9 9 0 9 0 0 21934567 18464 0 21953031 0 15603296 0 0 0 3192943 18796239 3156792 3657607 6580 3651027 NONE false false UNITYPOINT RURAL HEALTH ALLIANCE BENEFITS TRUST FUNDS THE BENEFITS OF THE PLAN WHICH PROVIDES VARIOUS TYPES OF GROUP INSURANCE COVERAGE FOR PARTICIPATING EMPLOYEES AND OTHER PARTICIPANTS. THE TRUST RECEIVES, CARES FOR, MANAGES AND INVESTS THE FUNDS CONTRIBUTED BY THE PARTICIPATING EMPLOYERS AND PAYMENTS MADE BY PARTICIPATING EMPLOYEES. false false false false false false false false false false false false true false true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 0 0 0 false false false false false false false false X 9 9 false false false false false false false true true false false true true true true false false false false false X ERPELDING VOIGT CO 5152957917 307 E CALL STREET ALGONA IA 50511 X BEN STEVENS TRUSTEE 1.00 0.50 X 0 0 0 ROB COLERICK TRUSTEE 1.00 0.50 X 0 0 0 GARY JORDAN TRUSTEE 1.00 0.50 X 0 0 0 CHAD BUTTERFIELD TRUSTEE 1.00 0.50 X 0 0 0 STACY JOHNSON TRUSTEE 1.00 0.50 X 0 0 0 JIM HENKENIUS TRUSTEE 1.00 0.50 X 0 0 0 MICHELLE SLEITER TRUSTEE TREA 1.00 0.50 X 0 0 0 BRIAN EVANS TRUSTEE SECR 1.00 0.50 X 0 0 0 JAMES ROETMAN TRUSTEE CHAI 1.00 0.50 X X 0 0 0 false false false ASSURED PARTNERS 4200 UNIVERSTIY AVE SUITE 200 WEST DES MOINES IA 50266 INS. CONSULTING 293960 MILLIMAN 1120 SOUTH 101ST STREET OMAHA NE 68124 ACTUARY SERVICE 102726 2 INSURANCE PREMIUMS 524298 20662208 20662208 PHARMACY REBATES 900099 916679 916679 EXCESS STOP LOSS 900099 355680 355680 21934567 16219 16219 2245 2245 2245 2245 21953031 21934567 18464 15603296 32481 21400 684 478495 STOP LOSS INS. PREMIUMS 1958548 ADMINISTRATIVE CHARGES 692374 8961 18796239 0 0 0 1128776 17334 2012014 499483 0 3657607 6580 0 6580 X 3651027 0 3651027 0 3657607 X 3156792 -5765 500000 X false true X true false PHARMACY REBATE RECEIVABLE 499483 499483 X 21946582 -5765 -684 -6449 21953031 21953031 18795555 18795555 684 684 18796239 SCHEDULE D, PAGE 3, PART X THE VEBA TRUST FUNDING THE BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE DATED MAY 13, 2021, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). UNRELATED BUSINESS INCOME TAX, IF ANY, WOULD BE RECORDED AS AN ADMINISTRATIVE EXPENSE OF THE PLAN. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN THE FISCAL YEAR ENDING DECEMBER 31, 2021 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE INCOME TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS IN PROGRESS FOR ANY TAX PERIODS. SCHEDULE D, PAGE 4, PART XI, LINE 2D INVESTMENT EXPENSES -684 FORM 990, PART VI SECTION B, QUESTIONS 13 AND 14: AS OF DECEMBER 31, 2021, THE TRUST DID NOT HAVE A WRITTEN WHISTLEBLOWER POLICY OR A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY IN PLACE. HOWEVER, AS OF THE DATE THIS RETURN WAS FILED, THE TRUST HAS ADOPTED THESE POLICIES. FORM 990, PAGE 6, PART VI, LINE 11B EACH YEAR BEFORE THE FINAL VERSION OF THE TRUST'S ANNUAL INFORMATION RETURN ON FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE, THE CHAIR OF UNITYPOINT RURAL HEALTH ALLIANCE BENEFITS TRUST SHALL DISTRIBUTE OR CAUSE TO BE DISTRIBUTED TO EACH TRUSTEE A COPY OF THE TRUST'S FORM 990, COMPLETE WITH ALL SCHEDULES AND ATTACHMENTS TO BE FILED. DISTRIBUTION MAY BE MADE IN PAPER OR ELECTRONIC FORM, OR BY PROVIDING THE TRUSTEES WITH A PASSWORD- PROTECTED WEBSITE ON WHICH THE ENTIRE FORM 990 CAN BE VIEWED. FORM 990, PAGE 6, PART VI, LINE 12C EACH TRUSTEE AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, AND C. HAS AGREED TO COMPLY WITH THE POLICY. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY MAJORITY VOTE OF THE DISINTERESTED TRUSTEE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 MEMBER CONTRIBUTIONS 500,000 UNITYPOINT RURAL HEALTH ALLIANCE BE 1776 WEST LAKES PARKWAY STE 400 WEST DES MOINES IA 50266 852360065 PLAN SPONS IA 501C4 N/A false PEOPLE'S MEMORIAL HOSPITAL N/A false BUENA VISTA REGIONAL HEALTHCARE FOU N/A false CHEROKEE REGIONAL MEDICAL CENTER FO N/A false CLARKE COUNTY HOSPITAL FOUNDATION N/A false GREENE COUNTY MEDICAL CENTER FOUNDA N/A false HUMBOLDT COUNTY MEMORIAL HOSPITAL F N/A false LORING HOSPITAL N/A false POCAHONTAS COMMUNITY HEALTHCARE FOU N/A false STEWART MEMORIAL COMMUNITY HOSPITAL N/A false false false false false false false false false false false false false true true true false false false false SCHEDULE R PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: NAME OF RELATED ORGANIZATION: UNITYPOINT RURAL HEALTH ALLIANCE BENEFITS PLAN PRIMARY ACTIVITY: PLAN ADMINISTRATION