WV - OH SUPPLEMENTAL HEALTH PLAN: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WV - OH SUPPLEMENTAL HEALTH PLAN (EIN 30-0002072)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-07
IRS object ID
201233129349301383
Schema version
2011v1.2
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)
Timestamp2012-11-07T14:11:15-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN341310124EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1REA & ASSOCIATES INC CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15775 PERIMETER DRIVE - STE 200AddressLine1
CityDUBLINCity
StateOHState
ZIP Code430173224ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN300002072EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WV-OH SUPPLEMENTAL HEALTH PLANBusinessNameLine1
Business Name Line2C/O AMERICAN BENEFIT CORPORATIONBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlWV-ONameControl
Phone3045250331Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1609 3RD AVENUEAddressLine1
CityCHESAPEAKECity
StateOHState
ZIP Code45619ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN CLARKEName
TitleBOARD CHAIRMANTitle
Phone3045250331Phone
Date Signed2012-11-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHELLE BROOKER CPAName
PTINP00099227PTIN
Phone6148898725Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN CLARKENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line182 BURKHAM COURTAddressLine1
CityWHEELINGCity
StateWVState
ZIP Code26003ZIPCode
FieldValueIRS element (for citing)
Gross Receipts910377GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2001YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionPROVIDING SUPPLEMENTAL HEALTH PREMIUMS AND WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year782693ProgramServiceRevenuePriorYear
Program Service Revenue CY762862ProgramServiceRevenueCY
Investment Income Prior Year154493InvestmentIncomePriorYear
Investment Income Current Year147515InvestmentIncomeCurrentYear
Other Revenue Prior Year610OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year937796TotalRevenuePriorYear
Total Revenue Current Year910377TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year555158BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY565563BenefitsPaidToMembersCY
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 Year43929OtherExpensePriorYear
Other Expenses Current Year43146OtherExpensesCurrentYear
Total Expenses Prior Year599087TotalExpensesPriorYear
Total Expenses Current Year608709TotalExpensesCurrentYear
Revenues Less Expenses Prior Year338709RevenuesLessExpensesPriorYear
Revenues Less Expenses CY301668RevenuesLessExpensesCY
Total Assets BOY3293248TotalAssetsBOY
Total Assets EOY3569234TotalAssetsEOY
Total Liabilities BOY12525TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3280723NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3569234NetAssetsOrFundBalancesEOY
Mission DescriptionTHE PROVIDISION OF SUPPLEMENTAL HEALTH PREMIUMS AND WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS (IBEW) UNIONS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTHE PROVISION OF SUPPLEMENTAL HEALTH INSURANCE PREMIUMS FOR ELIGIBLE MEMBERS OF THE PARTICIPATING LOCAL IBEW UNIONS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
DescriptionTHE PROVISION OF SUPPLEMENTAL DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING IBEW LOCAL UNIONS.Description
FieldValueIRS element (for citing)
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 Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
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
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
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
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
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 Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWVStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CO AMERICAN BENEFIT CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3045250331TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1609 THIRD AVENUEAddressLine1
CityCHESAPEAKECity
StateOHState
ZIP Code45619ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
STEVE CRUM
TRUSTEE0.80X000
DARWIN L SNYDER
TRUSTEE0.80X000
STEVEN ALLRED
TRUSTEE0.80X000
ROBERT KUBOVICZ
TRUSTEE0.80X000
JEFFREY A WILLIAMSON
TRUSTEE0.80X000
JAMES BANE
TRUSTEE0.80X000
DAVID YOUNG
TRUSTEE0.80X000
JEFF FOX
TRUSTEE0.80X000
WILLIAM HAMILTON
TRUSTEE0.80X000
BRIAN DAMANT
TRUSTEE0.80X000
JOHN CLARKE
BOARD CHAIRMAN1.30000X
DAVID K ROGERS
SECRETARY/ TREASURER0.80000X
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
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionEMPLOYER CONTRIBUTIONSDescription
Business Code525100BusinessCode
Total Revenue Column762862TotalRevenueColumn
Related Or Exempt Function Income762862RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue762862TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column147515TotalRevenueColumn
Exclusion$147,515ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column910377TotalRevenueColumn
Related Or Exempt Function Income762862RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$147,515ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total565563Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total20054Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8000Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total13277Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1315Total

Insurance Insurance

FieldValueIRS element (for citing)
Total500Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total608709Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY152785BOY
EOY127819EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY67477BOY
EOY84646EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3017452BOY
EOY3308121EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY55534BOY
EOY48648EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3293248BOY
EOY3569234EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12525BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12525BOY
EOY0EOY
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)
BOY3280723BOY
EOY3569234EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3280723BOY
EOY3569234EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3293248BOY
EOY3569234EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses301668ReconcilationRevenueExpenses
Reconcilation Other Changes-13157ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue910377TotalRevenue
Total Expenses608709TotalExpenses
Excess Or Deficit For Year301668ExcessOrDeficitForYear
Net Unrealized GL On Investments-13157NetUnrealizedGLOnInvestments
Total Adjustments-13157TotalAdjustments
Excess Or Deficit Per FS288511ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt897220TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-13157NetUnrealizedGainsInvestments
Revenue Not Rptd F990-13157RevenueNotRptdF990
Revenue Subtotal910377RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990910377TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt608709TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal608709ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990608709TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationOF SCHEDULE D: "THE PLAN IS DESIGNED TO CONSTITUTE A VOLUNTARY EMPLOYEE'S BENEFICIARY ASSOCIATION (VEBA) UNDER SECTION 50L (C) (9) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES. THE PLAN RECEIVED A FAVORABLE DETERMINATION LETTER DATED DECEMBER 3, 2003. THE PLAN AGREEMENT HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN'S LEGAL COUNSEL BELIEVES THAT THE PLAN IS DESIGNED AND IS CURRENTLY BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT OF AN ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT TO BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. PLAN MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2008."Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S FORM 990 IS PREPARED ANNUALLY BY AN INDEPENDENT ACCOUNTING FIRM. THE FIRM SENDS A DRAFT TO ONE OR MORE MEMBERS OF THE GOVERNING BODY TO BE DISTRIBUTED TO THE REMAINING MEMBERS BEFORE THE FORM IS SIGNED BY AN AUTHORIZED MEMBER AND FILED WITH THE APPROPRIATE TAX AUTHORITIES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES A COPY OF ITS FORM 1023 AND FORM 990 AVAIALBLE TO THE PUBLIC AS REQUIRED. AS PERMITTED, THE ORGANIZATION MAY CHOOSE TO MAKE ITS ORGANIZING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT ITS OWN DISCRETION. THE ORGANIZATION WOULD ALSO LIKE TO NOTE THAT IT'S MOST RECENTLY FILED RETURNS ARE GENERALLY AVAILABLE ELECTRONICALLY THROUGH THE FOLLOW WEBSITE, <WWW.GUIDESTAR.ORG>.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -13,157.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE ORGANIZATION'S BOARD OF TRUSTEES IS RESPONSIBLE FOR SELECTION OF AN INDEPENDENT ACCOUNTING FIRM AND FOR OVERSIGHT OF THE AUDIT. THIS INFORMATION IS NOT NEW AND HAS NOT CHANGES SINCE THE PRIOR YEAR.FINANCIAL STATEMENTS AND REPORTING

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