2022-11-12T11:46:38-06:00 2021-12-31 650140643 STEVEN D EISENBERG CPA PA 13790 NW 4 STREET 100 SUNRISE FL 33325 990 2021-01-01 630334002 SOUTHEASTERN IRON WORKERS WELFARE PLAN SOUT 6158590131 PO BOX 1449 GOODLETTSVILLE TN 37370 ROBERT DUFFIELD Chairman 6158590131 2022-11-10 1 ROBERT DUFFIELD 999009999 STEVEN D EISENBERG P00175252 9548469490 2022-11-12 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBERT DUFFIELD PO BOX 1449 GOODLETTSVILLE TN 37370 54965877 0 X N/A X 1953 TN To provide health benefits to its members. 16 0 0 0 0 0 0 0 31250978 30147968 1466692 3757062 0 0 32717670 33905030 0 0 28538222 30883055 0 0 0 0 0 1653145 1935216 30191367 32818271 2526303 1086759 50005292 49320694 160722 72039 49844570 49248655 The Organization mission to is provide health benefits to eligible participants 0 0 HEALTH CLAIMS PAID ON BEHALF OF PARTICIPANTS AND / OR THEIR DEPENDENTS 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 X SOUTHERN BENEFIT ADMINISTRATORS 6158590131 PO BOX 1449 GOODLETTSVILLE TN 37070 X ROBERT DUFFIELD CHAIRMAN 5.00 X X 0 0 0 PAUL METTE TRUSTEE 5.00 X 0 0 0 KEVIN BARBER TRUSTEE 5.00 X 0 0 0 YOSVANY TORRES TRUSTEE 5.00 X 0 0 0 ROBERT KNOST TRUSTEE 5.00 X 0 0 0 JEFF BAILEY TRUSTEE 5.00 X 0 0 0 WILLIAM BRADLEY TRUSTEE 5.00 X 0 0 0 DAN SEGOVIA TRUSTEE 5.00 X 0 0 0 ALEXANDER BERGEL TRUSTEE 5.00 X 0 0 0 STEPHEN SHELL TRUSTEE 5.00 X X 0 0 0 LESTER HENSLEY TRUSTEE 5.00 X 0 0 0 JIM BOYKIN TRUSTEE 5.00 X 0 0 0 CONRAD VARNUM TRUSTEE 5.00 X 0 0 0 WILLIAM McMILLAN TRUSTEE 5.00 X 0 0 0 JODY CREWS SECRETARY 5.00 X X 0 0 0 0 0 0 0 0 0 0 HCC LIFE INSURANCE COMPANY 225 TOWN PARK DRIVE STE 350 KENNESAW GA 30144 STOP LOSS COVERAGE 1054570 ANTHEM 3350 PEACHTREE ROAD NE ATLANTA GA 30326 PPO PROVIDER 981009 SOUTHERN BENEFIT ADMINISTRATORS INC PO BOX 1449 GOODLETTSVILLE TN 37070 CONTRACT ADMINISTRATION 617580 3 CONTRIBUTIONS 525100 30147968 30147968 30147968 1751535 1751535 23066374 21060847 2005527 2005527 2005527 33905030 32153495 0 1751535 30883055 24645 42004 141085 36500 43043 11493 11713 PPO ACCESS FEES 981009 PLAN ADMINISTRATION 617580 PCORI FEE 18349 BANK CHARGES 6080 1715 32818271 2355459 1361080 3451367 3360660 44198466 44598954 50005292 49320694 160722 72039 160722 72039 X 49844570 49248655 49844570 49248655 50005292 49320694 1086759 -1682674 0 X X 0 1 X 1 0 0 32081271 -1682674 -1682674 33763945 141085 141085 33905030 32677186 0 32677186 141085 141085 32818271 Form 990, Part VI, Section B, line 11b Form 990 is presented to the Board of Trustees for review. The return is reviewed and accepted. Any changes are made prior to filing. Form 990, Part VI, Section B, line 12c The Organization reviews it's conflict of interest policy on a regular basis, and requires Trustees to acknowledge their adherence to policy guidlines. Form 990, Part VI, Section C, line 19 The Organization makes its financial statements and governing documents available to the public upon written request. Form 990, Part XII, Line 2c: The Board of Trustees are responsible for the oversight of the audit. There has been no change in this process. INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #272 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #379 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #387 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #402 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #597 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #709 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #808 INTERNATIONAL ASSOC OF BSOR IRONWORKERS LOCAL #848 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0