2017-11-14T13:35:27-06:00 2016-12-31 132688836 ROGOFF & COMPANY PC 355 LEXINGTON AVENUE 6TH FLOOR NEW YORK NY 100176603 990 2016-01-01 133029280 Voluntary Hospitals House Staff Benefits Plan VOLU 2123568180 520 Eighth Avenue New York NY 10018 Earl Mathurin Benefit Plan Manager 2123568180 2017-11-02 1 HARRY WHITE P00646563 2125575666 24.136.113.242 2017-11-02 09:00:07 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D244D65BEBDE8FEA372D7314011873D6B2A69DFF 2016 2021-01-29 14:40:06Z Earl Mathurin 520 Eighth Avenue New York NY 10018 58032990 0 X www.cirseiu.org/benefits X 1980 NY To provide 501(c)(9) benefits to Voluntary Hospitals House Staff Benefits Plan participants. Benefits include medical, dental, legal, short and long-term disability, life insurance, training, education and others. 6 6 0 0 0 0 0 0 25841377 30410772 3489864 2325167 1021 459 29332262 32736398 0 0 29100855 31940460 0 0 0 0 0 2818943 2721759 31919798 34662219 -2587536 -1925821 45913444 42202256 4035094 3363177 41878350 38839079 To provide 501(c)(9) benefits to Voluntary Hospitals House Staff Benefits Plan participants. Benefits include medical, dental, legal,short and long-term disability, life insurance, training, education and others. 0 0 To provide 501(c)(9) benefits to Voluntary Hospitals House Staff Benefits Plan participants. Benefits include medical, dental, legal, short and long-term disability, life insurance, training, education and others. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 15 0 1 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Voluntary Hospitals House Staff Benefit Plan 2123568180 520 Eighth Avenue New York NY 10018 X Eric Scherzer Trustee 1.00 X 0 0 0 LAURA MCSPEDON Trustee 1.00 X 0 0 0 Dennis Buchanan Trustee 1.00 X 0 0 0 Selena Griffin-Mahon Trustee 1.00 X 0 0 0 Thomas Doherty trustee 1.00 X 0 0 0 JED TYRPAK Trustee 1.00 X 0 0 0 0 0 0 0 0 0 0 Empire Blue Cross 15 Metro Tech Center Brooklyn NY 11201 Benefit Administrator 1803256 House Staff Benefits Plan of CIR 520 Eigth Avenue New York NY 10018 Allocated PAYROLL 225172 2 Employer Contributions 525100 29425176 29425176 Participant Contributions 525100 985596 985596 30410772 1015150 1015150 26606609 25296592 1310017 1310017 1310017 other income 524298 459 459 459 32736398 30410772 0 2325626 31940460 44658 31900 182015 52057 19249 11167 4378 9458 23502 Empire Blue Cross 1803256 Allocated Payroll Expen 231558 TRANSITIONAL REINSURANC 169589 Allocated Common Expens 55191 83781 34662219 671421 2333009 495492 1982663 1529537 2689029 16765 1253 299885 164559 57693 135326 42893640 34475366 248896 585610 45913444 42202256 294844 246957 3740250 3116220 4035094 3363177 X 0 0 0 0 41878350 38839079 41878350 38839079 45913444 42202256 -1925821 -1113450 0 X 0 1 X 1 0 80474 39554 40920 219411 125005 94406 135326 Due to afilliates 60407 Claims incurred but not reported 2755600 PREPAID CONTRIBUTIONS 300213 3116220 31440933 -1113450 -1113450 32554383 182015 182015 32736398 34480204 0 34480204 182015 182015 34662219 Form 990, Part VI, Section B, line 11b Form 990 emailed and presented to trustees prior to filing Form 990, Part VI, Section B, line 12c Written statement from Officers, Trustees, and Key Employees required annually. Form 990, Part VI, Section B, line 15 There are no employees Form 990, Part VI, Section C, line 19 Governing documents are disclosed upon request