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SAS VEBA: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
SAS VEBA (EIN 35-7042070)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-03
IRS object ID
202243079349301529
Schema version
2021v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-03T11:42:08-04:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN581094351PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MCNAIR MCLEMORE MIDDLEBROOKS & CO LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1POST OFFICE BOX ONEAddressLine1Txt
CityMACONCityNm
State AbbreviationGAStateAbbreviationCd
ZIP312020001ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN357042070EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SAS VEBABusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSASVBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 THIRD STREETAddressLine1Txt
CityMACONCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31201ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonLORRAINE TAYLORPersonNm
Person TitleTRUSTEEPersonTitleTxt
Signature2022-11-03SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstLORRAINEPersonFirstNm
Person LastTAYLORPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJ RANDOLPH NICHOLSPreparerPersonNm
PTINP00347246PTIN
Phone4787466277PhoneNum
Preparation2022-11-03PreparationDt
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLORRAINE TAYLORPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 THIRD STREETAddressLine1Txt
CityMACONCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31201ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$26,850,962GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation2014FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionPROVIDE WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS FOR THOSE EMPLOYEES OF COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES COVERED BY THE TRUST.ActivityOrMissionDesc
Voting Members Governing Body0VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$24,519,037PYProgramServiceRevenueAmt
CY Program Service Revenue$25,399,343CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$989,484PYOtherRevenueAmt
CY Other Revenue$1,451,619CYOtherRevenueAmt
PY Total Revenue$25,508,521PYTotalRevenueAmt
CY Total Revenue$26,850,962CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$27,011,640PYOtherExpensesAmt
CY Other Expenses$29,273,221CYOtherExpensesAmt
PY Total Expenses$27,011,640PYTotalExpensesAmt
CY Total Expenses$29,273,221CYTotalExpensesAmt
PY Revenues Less Expenses-$1,503,119PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,422,259CYRevenuesLessExpensesAmt
Total Assets BOY$3,424,212TotalAssetsBOYAmt
Total Assets EOY$992,706TotalAssetsEOYAmt
Total Liabilities BOY$5,162,682TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,865,716TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$1,738,470NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$2,873,010NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPROVIDE WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS FOR THOSE EMPLOYEES OF COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES COVERED BY THE TRUST.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescVEBA REVENUES CONSIST OF CONTRIBUTIONS FROM COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES AND EMPLOYEES. ALL REVENUES ARE TO BE USED FOR PROVIDING WELFARE BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
DescVEBA REVENUES CONSIST OF CONTRIBUTIONS FROM COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES AND EMPLOYEES. ALL REVENUES ARE TO BE USED FOR PROVIDING WELFARE BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS.Desc
FieldValueIRS element (for citing)
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members0GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SAS VEBABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4786212100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 THIRD STREETAddressLine1Txt
CityMACONCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31201ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RONNIE ROLLINS
TRUSTEE0.0040.00Yes (X)$0$823,442$26,000
LORRAINE TAYLOR
TRUSTEE0.0040.00Yes (X)$0$735,759$26,000
KATHRYN DENNIS
TRUSTEE0.004.00Yes (X)$0$24,000$0
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$1,583,201TotReportableCompRltdOrgAmt
Total Other Compensation$52,000TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtAddress Line2ContractorAddress/USAddress/AddressLine2TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BENEFIT ADMINISTRATIVE SYSTEMS LLC
17475 JOVANNA DRIVESUITE 18HOMEWOODIL60430INSURANCE SRVCS$28,343,624
VOYA
7632 SW DURHAM ROADSUITE 115TIGARDOR97224INSURANCE SRVCS$1,169,936
THE BENEFIT COMPANY LLC
SIX CONCOURSE PARKWAYSUITE 2750ATLANTAGA30328INSURANCE SRVCS$255,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescCONTRIBUTIONSDesc
Business524298BusinessCd
Total Revenue Column$25,399,343TotalRevenueColumnAmt
Related Or Exempt Func Income$25,399,343RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$25,399,343TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHERDesc
Business524298BusinessCd
Total Revenue Column$1,451,619TotalRevenueColumnAmt
Related Or Exempt Func Income$1,451,619RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,451,619OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,850,962TotalRevenueColumnAmt
Related Or Exempt Func Income$26,850,962RelatedOrExemptFuncIncomeAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$26,197TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$28,000TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$26,690,253TotalAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmt
CONTRACT SERVICES$2,527,389
BANK CHARGES$885
POSTAGE$497

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$29,273,221TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,103,289BOYAmt
EOY$2,370EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,320,352BOYAmt
EOY$990,336EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$571BOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,424,212BOYAmt
EOY$992,706EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,162,682BOYAmt
EOY$3,865,716EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,162,682BOYAmt
EOY$3,865,716EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY-$1,738,470BOYAmt
EOY-$2,873,010EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$1,738,470BOYAmt
EOY-$2,873,010EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,424,212BOYAmt
EOY$992,706EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,422,259ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$1,287,719OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
RONNIE ROLLINS
TRUSTEE$823,442$26,000$849,442
LORRAINE TAYLOR
TRUSTEE$735,759$26,000$761,759

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART IIIFormAndLineReferenceDesc
ExplanationCOMPENSATION FOR TRUSTEES PAID FROM A RELATED ORGANIZATION IS DETERMINED BASED ON THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, REVIEW OF FORM 990S OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4DVEBA REVENUES CONSIST OF CONTRIBUTIONS FROM COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES AND EMPLOYEES. ALL REVENUES ARE TO BE USED FOR PROVIDING WELFARE BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS.
FORM 990, PAGE 6, PART VI, LINE 11BFORM 990 IS REVIEWED BY SAS VEBA'S TRUSTEES WITH ALL SUPPORTING DOCUMENTATION MADE AVAILABLE TO THEM.
FORM 990, PAGE 6, PART VI, LINE 12CTHE TRUSTEES, AS EMPLOYEES OF COMMUNITY HEALTH SYSTEMS, INC. (CHSI), ARE SUBJECT TO CHSI'S CONFLICT OF INTEREST POLICY. CHSI REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THEIR CONFLICT OF INTEREST POLICY AS PROVIDED FOR IN THEIR POLICY.
FORM 990, PAGE 6, PART VI, LINE 19COMMUNITY HEALTH SYSTEMS, INC. MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AS PART OF ITS FORM 990. THE VEBA TRUST ALSO MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AS PART OF ITS FORM 990. BOTH 990'S ARE AVAILABLE UPON REQUEST AS REFLECTED IN PART VI SECTION C LINE 18.
FORM 990, PART XI, LINE 9BENEFIT OBLIGATION - IBNR 1,287,719

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