2017-07-26T07:53:51-05:00 2016-10-01 560747981 DIXON HUGHES GOODMAN LLP 100 N MAIN STREET SUITE 2300 WINSTONSALEM NC 27101 990 2015-10-04 570742607 ALEX LEE INC VOLUNTARY EMPLOYEES BENEFICIARY ASSOC ALEX 8287254424 PO BOX 800 HICKORY NC 28603 ANDREW ALMQUIST CFO 8287254424 2017-07-20 1 DAVID VOGLER P00187735 3367148100 2017-07-20 2015 2021-01-29 14:40:06Z ANDREW ALMQUIST PO BOX 800 HICKORY NC 28603 16673649 0 X N/A X 1982 NC TO PROVIDE MEDICAL, DENTAL AND VISION BENEFITS TO PARTICIPATING & FORMER EMPLOYEES & DEPENDENTS. X 0 0 0 0 19512 16951 0 0 31495960 16634241 9927 19512 0 19896 31505887 16673649 0 0 28868228 25096142 23514 15373 0 0 0 2600751 1823381 31492493 26934896 13394 -10261247 10261247 0 0 0 10261247 0 X TO PROVIDE MEDICAL, DENTAL AND VISION BENEFITS TO PARTICIPATING EMPLOYEES AND THEIR DEPENDENTS, AND TO RETIRED FORMER EMPLOYEES. 0 1 26934896 16634241 PROVIDED MEDICAL, DENTAL AND VISION BENEFITS TO PARTICIPATING EMPLOYEES AND THEIR DEPENDENTS, AND RETIRED FORMER EMPLOYEES. 26934896 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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 1 0 0 0 1 1 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 X WELLS FARGO 7043744042 401 S TRYON ST CHARLOTTE NC 28202 WELLS FARGO TRUSTEE 1.00 X 15373 0 0 15373 0 0 0 0 0 0 AETNA LIFE INSURANCE COMPANY 151 FARMINGTON AVENUE HARTFORD CT 06156 CONTRACT ADMINISTRATOR 1843664 1 CONTRIBUTIONS 900001 16634241 16634241 16634241 19512 19512 OTHER RECEIPTS 900001 19896 19896 19896 16673649 16634241 19512 19896 25096142 25096142 15373 15373 11000 11000 1800962 1800962 ACTUARIAL FEE 6260 6260 12 B-1 FEES 5159 5159 26934896 26934896 0 0 18814 0 10242433 0 10261247 0 0 0 X 0 0 0 0 10261247 0 10261247 0 10261247 0 -10261247 0 X X 0 1 X 1 0 0 X 26201521 9528454 9528454 16673067 582 582 16673649 36482000 9528454 9528454 26953546 -18650 -18650 26934896 PART X, LINE 2: THE PLAN SPONSOR HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2016. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASS CONTRIBUTIONS 9,528,454. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST RECEIVABLE 582. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS CONTRIBUTIONS 9,528,454. PART XII, LINE 4B - OTHER ADJUSTMENTS: BENEFITS 558. ADMINISTRATIVE EXPENSE -19,208. SCH. D, PART XI LINE 4B PART XI, LINE 4B - ACCRUED INTEREST RECEIVABLE INCLUDED ON CASH BASIS FORM 990 - ($582). SCH. D, PART XII LINE 4B PART XII, LINE 4B - ADMINISTRATIVE EXPENSES NOT RECORDED ON FINANCIAL STATEMENTS, INCLUDED ON CASH BASIS FORM 990 IN CURRENT YEAR - ($19,208). SCH. D, PART XII LINE 4B PART XII, LINE 4B - BENEFIT PAYMENTS NOT RECORDED ON FINANCIAL STATEMENTS, INCLUDED ON CASH BASIS FORM 990 IN CURRENT YEAR - $558. CASH AND CASH EQUIVALENTS USED FOR PAYING CLAIMS BENEFITS AND ADMINISTRATIVE EXPENSES 2016-09-30 10261247 BOOK VALUE MEMBER BENEFICIARIES 0 0 0 0 FORM 990, PART III, LINE 3 THE VOLUNTARY EMPLOYEES BENEFICIARY ASSOCIATION (VEBA) TRUST TERMINATED IN SEPTEMBER 2016, AND BEGAN THE PROCESS OF LIQUIDATION OF ASSETS FOR THE BENEFIT OF ITS MEMBERS. THE LIQUIDATION IS MOSTLY COMPLETE AS OF THE END OF THIS FISCAL YEAR, WITH THE FINAL ASSET (UBI TAX RECEIVABLE) TO BE DISTRIBUTED UPON RECEIPT IN THE NEXT FISCAL YEAR. FORM 990, PART VI, SECTION A, LINE 8A THE ORGANIZATION IS A VOLUNTARY EMPLOYEES BENEFICIARY ASSOCIATION (VEBA) AND AS SUCH DOES NOT HAVE A GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION IS A VOLUNTARY EMPLOYEES BENEFICIARY ASSOCIATION (VEBA) AND AS SUCH DOES NOT HAVE A GOVERNING BODY OR COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION IS A VOLUNTARY EMPLOYEES BENEFICIARY ASSOCIATION (VEBA) AND AS SUCH DOES NOT HAVE A GOVERNING BODY. FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE FORM IS COMPLETED USING DATA RECEIVED FROM THE TRUSTEE FOR THE SPECIFIC FISCAL YEAR. FORM 990 AND ALL SUPPORTING SCHEDULES ARE REVIEWED AND APPROVED BY THE CORPORATE CONTROLLER OF ALEX LEE, INC. FORM 990, PART VI, SECTION C, LINE 19 AS A VOLUNTARY EMPLOYEES BENEFIT ASSOCIATION (VEBA) NO DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VII WELLS FARGO - 401 S. TRYON ST., CHARLOTTE, NC 28202. FORM 990, PART XII, LINE 2C: THERE IS NO CHANGE SINCE THE PRIOR YEAR.