SOUTHEASTERN CARP & MW HEALTH PLAN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SOUTHEASTERN CARP & MW HEALTH PLAN (EIN 58-6066597)
Tax period
2012-04-01 to 2013-03-31
Filed
2013-07-17
IRS object ID
201301989349300005
Schema version
2012v2.1
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)
Timestamp2013-07-17T07:50:11-05:00Timestamp
Tax Period End Date2013-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1J ALLEN BELL JR CPABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1333 SANDY SPRINGS CIRCLE STE 120AddressLine1
CityATLANTACity
StateGAState
ZIP Code30328ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN586066597EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTHEASTERN CARP & MW HEALTH PLANBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSOUTNameControl
Phone6158590131Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12001 CALDWELL DRIVEAddressLine1
CityGOODLETTSVILLECity
StateTNState
ZIP Code37072ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKIRK MALONEName
TitleCHAIRMANTitle
Phone6158590131Phone
Date Signed2013-06-19DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJ ALLEN BELL JRName
Phone4042557084Phone
Date Prepared2013-07-17DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKIRK MALONENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12001 CALDWELL DRIVEAddressLine1
CityGOODLETTSVILLECity
StateTNState
ZIP Code37072ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23443809GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1967YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionPAYMENT OF ELIGIBLE HEALTH, VISION, DENTAL, DISABILITY AND DEATH BENEFIT CLAIMS FOR PLAN'S ELIGIBLE MEMBERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees65TotalNbrEmployees
Total Nbr Volunteers7TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13987733ProgramServiceRevenuePriorYear
Program Service Revenue CY12221327ProgramServiceRevenueCY
Investment Income Prior Year342286InvestmentIncomePriorYear
Investment Income Current Year216318InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year14330019TotalRevenuePriorYear
Total Revenue Current Year12437645TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year14846386BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY16432753BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year701614OtherExpensePriorYear
Other Expenses Current Year682539OtherExpensesCurrentYear
Total Expenses Prior Year15548000TotalExpensesPriorYear
Total Expenses Current Year17115292TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1217981RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-4677647RevenuesLessExpensesCY
Total Assets BOY20332440TotalAssetsBOY
Total Assets EOY15827572TotalAssetsEOY
Total Liabilities BOY265104TotalLiabilitiesBOY
Total Liabilities EOY237572TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY20067336NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY15590000NetAssetsOrFundBalancesEOY
Mission DescriptionPAYMENT OF ELIGIBLE HEALTH, VISION, DENTAL, DISABILITY AND DEATH BENEFIT CLAIMS FOR PLAN'S ELIGIBLE MEMBERS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense16877753Expense
DescriptionPROVIDE HEALTH, VISION, DENTAL, DISABILITY AND DEATH BENEFITS FOR APPROXIMATELY 1900 ELIGIBLE MEMBERS AND THEIR DEPENDENTS.Description
Total Program Service Expense16877753TotalProgramServiceExpense
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096338NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees65NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJERE T BRASSELLNamePerson
Telephone Number6158590131TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12001 CALDWELL DRAddressLine1
CityGOODLETTSVILLECity
StateTNState
ZIP Code37072ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelated
KIRK MALONE
TRUSTEE1.00XX000
JIM WILKERSON
TRUSTEE1.00X000
LARRY PHILLIPS
TRUSTEE1.00XX000
MICHAEL HAMILTON
TRUSTEE1.00X0000.00
MARK BROWN
TRUSTEE1.00X0000.00
TOM JENKINS
TRUSTEE1.00X0000.00
DAVID W TANKERSLEY
TRUSTEE1.00X0000.00
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1Address Line2AddressOfContractor/AddressUS/AddressLine2CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CIGNA CORPORATION
TWO LIBERTY PLACE1601 CHESTNUT STREETPHILADELPHIAPA19192PPO CONSULT583683
SOUTHERN BENEFIT ADMIN INC
2001 CALDWELL DRIVEGOODLETTSVILLETN37072THIRD PARTY ADM508800
LINCOLN FINANCIAL GROUP
1800 PEMBROOK DR ST 150ORLANDOFL32810LIFE INS UNDWR154111
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionHEALTH BENEFIT COVERAGE RECDescription
Business Code525100BusinessCode
Total Revenue Column12221327TotalRevenueColumn
Related Or Exempt Function Income12221327RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue12221327TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column281538TotalRevenueColumn
Related Or Exempt Function Income281538RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities10940944Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities11006164Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-65220Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-65220TotalRevenueColumn
Related Or Exempt Function Income-65220RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12437645TotalRevenueColumn
Related Or Exempt Function Income12437645RelatedOrExemptFunctionIncome

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total16432753Total
Program Services16432753ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total493800Total
Program Services420000ProgramServices
Management And General73800ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total36523Total
Management And General36523ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total34000Total
Management And General34000ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total34623Total
Management And General34623ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total21500Total
Management And General21500ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total38612Total
Program Services25000ProgramServices
Management And General13612ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total10992Total
Management And General10992ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total12489Total
Management And General12489ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17115292Total
Program Services16877753ProgramServices
Management And General237539ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Info In Schedule O Part XXInfoInScheduleOPartX

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1053921BOY
EOY634372EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1529996BOY
EOY1528465EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY740BOY
EOY507EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17747783BOY
EOY13664228EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20332440BOY
EOY15827572EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY265104BOY
EOY237572EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY265104BOY
EOY237572EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY20067336BOY
EOY15590000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20067336BOY
EOY15590000EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20332440BOY
EOY15827572EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-4677647ReconcilationRevenueExpenses
Reconciliation Unrealized Invest200311ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Tot Revenue Etc Audited Fincl Stmt12603333TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments200311NetUnrealizedGainsInvestments
Revenue Not Rptd F990200311RevenueNotRptdF990
Revenue Subtotal12403022RevenueSubtotal
Investment Expenses Not Included34623InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt34623RevenueNotRptdOnFinStmt
Total Revenue Per Form99012437645TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17080669TotExpensesEtcAuditedFinclStmt
Expenses Subtotal17080669ExpensesSubtotal
Investment Expenses Not Included234623InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt34623ExpensesNotRptdOnFinStmt
Total Expenses Per Form99017115292TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3EMPLOYED A THIRD PARY ADMINISTRATOR: SOUTHERN BENEFIT ADMINISTRATORS, INC., GOODLETTSVILLE, TN
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ATHE MANAGEMENT TRUSTEES SERVE AS TRUSTEES UNTIL THEY RESIGN, DIE OR BECOME INCAPACITATED. A REPLACEMENT OF A MANAGEMENT TRUSTEE IS SELECTED BY THE REMAINING MANAGEMENT TRUSTEES WHEN A VACANCY OCCURS. THE LABOR TRUSTEES SERVE AS TRUSTEES AT THE PLEASURE OF THE SOUTHEASTERN REGIONAL COUNCIL OF THE INTERNATIONAL BROTHERHOOD OF CARPENTERS AND JOINERS OF AMERICA.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BA COPY OF FORM 990 AND ALL RELATED ATTACHMENTS WERE EMAILED TO ALL TRUSTEES OF ITS GOVERNING BODY IN MID-JUNE, 2012 BEFORE THE RETURN WAS FILED IN JULY, 2012. ALL TRUSTEES WERE REQUESTED TO ASK ANY QUESTIONS OF THE RETURN PREPARER BEFORE THE RETURN WAS FILED AND NO QUESTIONS WERE RECEIVED BY THE RETURN PREPARER BEFORE IT WAS FILED.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CWHENEVER A MEMBER OF THE GOVERNING BOARD CONSIDERS ANY ITEM THAT HE DOES OR KNOWS THAT ANOTHER GOVERNING BOARD MEMBER DOES SOMETHING THAT MAY BE A CONFLICT OF INTEREST, HE BRINGS THIS ITEM BEFORE THE FULL BOARD FOR THEM TO DETERMINE IF ANY ACTION IS NECESSARY BY THEM.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AS REQUIRED BY ERISA.

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