2018-11-13T16:02:15-06:00 2017-12-31 721447490 BROUSSARD & COMPANY CPAS LLC 127 WEST BROAD STREET SUITE 800 LAKE CHARLES LA 70601 990 2017-01-01 760175369 UNITED STRUCTURES OF AMERICA INC HEALTH PLAN & TRUST UNIT 2814428247 1912 BUSCHONG HOUSTON TX 77039 DARYL DARBY TRUSTEE 2814428247 2018-11-06 1 RICK ROBERT CPA P00031513 3374396600 2018-11-06 12.5.200.170 2018-11-06 16:15:02 CS P 03B6F078C68BDB6BBAEEC1F8D18E787E8094AA3D 03B6F078C68BDB6BBAEEC1F8D18E787E8094AA3D 2017 2019-02-21 02:37:17Z DARYL DARBY 1912 BUSCHONG HOUSTON TX 77039 3958043 0 X N/A X 1986 TX TO PROVIDE MEDICAL, DENTAL, LIFE INSURANCE, AND DISABILITY INSURANCE COVERAGE TO PLAN PARTICIPANTS. 3 3 0 0 0 0 0 0 2880446 3958043 0 0 0 0 2880446 3958043 0 0 2488776 3354177 0 0 0 0 0 602843 664046 3091619 4018223 -211173 -60180 105307 129195 37972 122040 67335 7155 TO PROVIDE MEDICAL, DENTAL, LIFE, AND DISABILITY BENEFITS TO PLAN PARTICPANTS. 0 0 4018223 3958043 THIS WELFARE BENEFIT PLAN PROVIDES MEDICAL, DENTAL, LIFE, AND DISABILITY BENEFITS TO PLAN PARTICIPANTS. 4018223 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 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 TX X DARYL DARBY 2814428247 1912 BUSCHONG HOUSTON TX 77039 X DAIN DRAKE TRUSTEE 1.00 X X 0 0 0 KYLE PARRISH TRUSTEE 1.00 X X 0 0 0 DARYL DARBY TRUSTEE 1.00 X X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD OF TEXAS 1001 E LOOKOUT DRIVE RICHARDSON TX 75082 ADMINISTRATIVE FEES BEFORE PREMIUM ADJUS 172868 BOON CHAPMAN 2180 NORTH LOOP W 400 HOUSTON TX 77018 PLAN ADMINISTRATION BEFORE PREMIUM ADJUS 155866 2 EMPLOYER CONTRIBUTIONS 525100 2196783 2196783 EMPLOYEE CONTRIBUTIONS 525100 1505563 1505563 SPECIFIC INSURANCE REI 525100 241481 241481 COBRA CONTRIBUTIONS 525100 14216 14216 3958043 3958043 3958043 0 0 3354177 3354177 335312 335312 THIRD PARTY CLAIMS ADMI 328734 328734 4018223 4018223 0 0 105307 129195 105307 129195 14027 24889 23945 97151 37972 122040 X 0 0 0 0 67335 7155 67335 7155 105307 129195 -60180 0 X 0 0 0 0 BENEFIT CLAIMS PAYABLE 97151 97151 X PART X, LINE 2: FROM THE AUDITOR'S REPORT: "THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S NET ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE. THE SPONSOR HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE AND THE SPONSOR BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE AS DESIGNED. TAXABLE INCOME TO THE TRUST IS DEFINED IN SUCH A WAY THAT YIELDS NO TAX LIABILITY FOR THE CURRENT YEAR. ACCORDINGLY, NO TAX LIABILITY OR EXPENSE IS REFLECTED IN THE FINANCIAL STATEMENTS. THE PLAN IS CURRENT WITH ALL TAX FILINGS AND HAS THREE OPEN YEARS SUBJECT TO EXAMINATION FROM FEDERAL AUTHORITIES. THE ACCOUNTING STANDARD ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE PLAN MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES FOR THE YEAR ENDED DECEMBER 31, 2016. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE TRUSTEES BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE BY CALLING OR WRITING TO THE OFFICE OF THE PLAN SPONSOR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, ETC ARE ALL AVAILABLE UPON REQUEST BY CALLING OR WRITING TO THE OFFICE OF THE PLAN SPONSOR.