VOLUNTARY HOSPITALS HOUSE STAFF BNFTS PLN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
VOLUNTARY HOSPITALS HOUSE STAFF BNFTS PLN (EIN 13-3029280)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201303179349302510
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)
Timestamp2013-11-13T11:16:05-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN132688836EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ROGOFF & COMPANY PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1355 LEXINGTON AVENUEAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code100176603ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN133029280EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1VOLUNTARY HOSPITALS HOUSE STAFFBusinessNameLine1
Business Name Line2BENEFITS PLAN OF CIRBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlVOLUNameControl
Phone2123568180Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1520 EIGHTH AVENUEAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10018ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEARL MATHURINName
TitleBENEFIT PLAN MANAGERTitle
Phone2123568180Phone
Date Signed2013-11-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHARRY WHITEName
PTINP00646563PTIN
Phone2125575666Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonEARL MATHURINNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1520 EIGHTH AVENUEAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10018ZIPCode
FieldValueIRS element (for citing)
Gross Receipts37398828GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.CIRSEIU.ORG/BENEFITSWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1980YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE 501(C)(9) BENEFITS TO VOLUNTARY HOSPITALS HOUSE STAFF BENEFITS PLAN PARTICIPANTS. BENEFITS INCLUDE MEDICAL, DENTAL, SHORT AND LONG-TERM DISABILITY, LIFE INSURANCE, AND OTHERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21964768ProgramServiceRevenuePriorYear
Program Service Revenue CY22064492ProgramServiceRevenueCY
Investment Income Prior Year2305637InvestmentIncomePriorYear
Investment Income Current Year1917096InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year24270405TotalRevenuePriorYear
Total Revenue Current Year23981588TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year19975298BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY21444177BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3168164OtherExpensePriorYear
Other Expenses Current Year3998087OtherExpensesCurrentYear
Total Expenses Prior Year23143462TotalExpensesPriorYear
Total Expenses Current Year25442264TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1126943RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1460676RevenuesLessExpensesCY
Total Assets BOY46288476TotalAssetsBOY
Total Assets EOY45543343TotalAssetsEOY
Total Liabilities BOY2642749TotalLiabilitiesBOY
Total Liabilities EOY2920603TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY43645727NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY42622740NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE 501(C)(9) BENEFITS TO VOLUNTARY HOSPITALS HOUSE STAFF BENEFITS PLAN PARTICIPANTS. BENEFITS INCLUDE MEDICAL, DENTAL, SHORT AND LONG-TERM DISABILITY, LIFE INSURANCE, AND OTHERS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE 501(C)(9) BENEFITS TO VOLUNTARY HOSPITALS HOUSE STAFF BENEFITS PLAN PARTICIPANTS. BENEFITS INCLUDE MEDICAL, DENTAL, SHORT AND LONG-TERM DISABILITY, LIFE INSURANCE, AND OTHERS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1VOLUNTARY HOSPITALS HOUSE STAFF BENEFIT PLANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2123568180TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1520 EIGHTH AVENUEAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10018ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ERIC SCHERZER
TRUSTEE1.00X000
RALPH STAULCUP
TRUSTEE1.00X000
DENNIS BUCHANAN
TRUSTEE1.00X000
MICHAEL PHELAN
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EMPIRE BLUE CROSS
15 METRO TECH CENTERBROOKLYNNY11201BENEFIT ADMINISTRATOR3203964
HOUSE STAFF BENEFITS PLAN OF CIR
520 EIGTH AVENUENEW YORKNY10018ALLOCATED PR217964
STEPHEN M PERLITSH
110 WEST 34TH STREETNEW YORKNY10001LEGAL112145
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS5251202123723321237233
PARTICIPANT CONTRIBUTIONS525120827259827259
FieldValueIRS element (for citing)
Total Program Service Revenue22064492TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1053048TotalRevenueColumn
Exclusion$1,053,048ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities14281288Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities13417240Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities864048Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column864048TotalRevenueColumn
Exclusion$864,048ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23981588TotalRevenueColumn
Related Or Exempt Function Income22064492RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,917,096ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total21444177Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total31506Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total29000Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total221132Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total77190Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total21645Total

Travel Travel

FieldValueIRS element (for citing)
Total2679Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1518Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total26920Total

Insurance Insurance

FieldValueIRS element (for citing)
Total26393Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
EMPIRE BLUE CROSS3203964
ALLOCATED PAYROLL EXPEN223892
ALLOCATED COMMON EXPENS73513
COMPUTER NETWORK EXPENS25083

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total33652Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total25442264Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2371336BOY
EOY1310071EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1540503BOY
EOY556779EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1547398BOY
EOY1728935EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY18978BOY
EOY224234EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis203413LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec76822LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY81088BOY
EOY126591EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY40464246BOY
EOY41336006EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY264927BOY
EOY260727EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY46288476BOY
EOY45543343EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY40885BOY
EOY105475EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2601864BOY
EOY2815128EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2642749BOY
EOY2920603EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY43645727BOY
EOY42622740EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY43645727BOY
EOY42622740EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY46288476BOY
EOY45543343EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1460676ReconcilationRevenueExpenses
Reconciliation Unrealized Invest437689ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis73664OtherCostOrOtherBasis
Depreciation7366Depreciation
Book Value66298BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis129749OtherCostOrOtherBasis
Depreciation69456Depreciation
Book Value60293BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings126591TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO AFILLIATES$96,938
PREPAID CONTRIBUTIONS$267,190
CLAIMS INCURRED BUT NOT REPORTED$2,451,000
FieldValueIRS element (for citing)
Total Of Amounts2815128TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt24198145TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments437689NetUnrealizedGainsInvestments
Revenue Not Rptd F990437689RevenueNotRptdF990
Revenue Subtotal23760456RevenueSubtotal
Investment Expenses Not Included221132InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt221132RevenueNotRptdOnFinStmt
Total Revenue Per Form99023981588TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt25221132TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal25221132ExpensesSubtotal
Investment Expenses Not Included2221132InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt221132ExpensesNotRptdOnFinStmt
Total Expenses Per Form99025442264TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11FORM 990 EMAILED TO TRUSTEES PRIOR TO FILING
FORM 990, PART VI, SECTION B, LINE 12CWRITTEN STATEMENT FROM OFFICERS, TRUSTEES, AND KEY EMPLOYEES REQUIRED ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15THERE ARE NO EMPLOYEES
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS ARE DISCLOSED UPON REQUEST

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