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TEAMSTERS LOCAL 922 EMPLOYERS HEALTH TRUST: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
TEAMSTERS LOCAL 922 EMPLOYERS HEALTH TRUST (EIN 52-1158708)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-05
IRS object ID
202222179349301602
Schema version
2020v4.2
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)
Return2022-08-05T14:28:58-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN470900880PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CALIBRE CPA GROUP PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line17501 WISCONSIN AVENUE STE 1200WAddressLine1Txt
CityBETHESDACityNm
State AbbreviationMDStateAbbreviationCd
ZIP20814ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521158708EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TEAMSTERS LOCAL 922 - EMPLOYERS HEALTHBusinessNameLine1Txt
Business Name Line2TRUSTBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlTEAMBusinessNameControlTxt
Phone4108729500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17130 COLUMBIA GATEWAY DRIVE NO AAddressLine1Txt
CityCOLUMBIACityNm
State AbbreviationMDStateAbbreviationCd
ZIP21046ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRUDOLPH GARDNERPersonNm
Person TitleTRUSTEEPersonTitleTxt
Phone4108729500PhoneNum
Signature2022-07-26SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstRUDOLPHPersonFirstNm
Person LastGARDNERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOSEPH M HERISHEN CPAPreparerPersonNm
PTINP00361968PTIN
Phone2023319880PhoneNum
Preparation2022-08-05PreparationDt
Self EmployedYes (X)SelfEmployedInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRUDOLPH GARDNERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line17130 COLUMBIA GATEWAY DRIVEAddressLine1Txt
CityCOLUMBIACityNm
State AbbreviationMDStateAbbreviationCd
ZIP21406ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,287,362GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1979FormationYr
Legal Domicile StateMDLegalDomicileStateCd
Activity Or MissionTHE FUND PROVIDES MEDICAL,SURGICAL,HOSPITALIZATION, VISION CARE AND DENTAL BENEFITS PURSUANT TO CERTAIN COLLECTIVE BARGAINING AGREEMENTS.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$24,082TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$6,650,520PYProgramServiceRevenueAmt
CY Program Service Revenue$6,874,537CYProgramServiceRevenueAmt
PY Investment Income$5,534PYInvestmentIncomeAmt
CY Investment Income$24,082CYInvestmentIncomeAmt
PY Other Revenue$195,700PYOtherRevenueAmt
CY Other Revenue$388,743CYOtherRevenueAmt
PY Total Revenue$6,851,754PYTotalRevenueAmt
CY Total Revenue$7,287,362CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$4,315,588PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$6,052,902CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$332,156PYOtherExpensesAmt
CY Other Expenses$337,900CYOtherExpensesAmt
PY Total Expenses$4,647,744PYTotalExpensesAmt
CY Total Expenses$6,390,802CYTotalExpensesAmt
PY Revenues Less Expenses$2,204,010PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$896,560CYRevenuesLessExpensesAmt
Total Assets BOY$4,165,357TotalAssetsBOYAmt
Total Assets EOY$4,956,292TotalAssetsEOYAmt
Total Liabilities BOY$98,439TotalLiabilitiesBOYAmt
Total Liabilities EOY$22,254TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,066,918NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,934,038NetAssetsOrFundBalancesEOYAmt
MissionNONEMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$6,390,802ExpenseAmt
DescTHE FUND PROVIDED GROUP LIFE, DISABILITY, HOSPITALIZATION, SURGICAL ,MEDICAL, VISION AND DENTAL BENEFITS TO ELIGIBLE PARTICIPANTS UNDER VARIOUS COLLECTIVE BARGAINING AGREEMENTS.Desc
Total Program Service Expenses$6,390,802TotalProgramServiceExpensesAmt
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn0AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc0RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CARDAY ASSOCIATES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4108729500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17130 COLUMBIA GATEWAY DRIVE STE AAddressLine1Txt
CityCOLUMBIACityNm
State AbbreviationMDStateAbbreviationCd
ZIP21046ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RUDOLPH GARDNER
UNION TRUSTEE2.00Yes (X)$0$0$0
SHERRI DICKERSON
EMPLOYER TRUSTEE2.00Yes (X)$0$0$0
TIMOTHY BROWN
UNION TRUSTEE2.00Yes (X)$0$0$0
MICHAEL GOBLE
EMPLOYER TRUSTEE2.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BENESYS INCBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line17130 COLUMBIA GATEWAY DR SUITE AAddressLine1Txt
CityCOLUMBIACityNm
State AbbreviationMDStateAbbreviationCd
ZIP21046ZIPCd
FieldValueIRS element (for citing)
ServicesADMINISTRATIVEServicesDesc
Compensation$187,482CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
EMPLOYER CONTRIBUTIONS525100$4,928,271$4,928,271
PARTICIPANT CONTRIBUTI525100$1,946,266$1,946,266
FieldValueIRS element (for citing)
Total Program Service Revenue$6,874,537TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,082TotalRevenueColumnAmt
Unrelated Business Revenue$24,082UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PRESCRIPTION REBATE525100$338,714$338,714
RX PERFORMANCE GUARANT525100$49,138$49,138
SUBROGATION525100$888$888

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3TotalRevenueColumnAmt
Related Or Exempt Func Income$3RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$388,743OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,287,362TotalRevenueColumnAmt
Related Or Exempt Func Income$7,263,280RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$24,082UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$6,052,902TotalAmt
Program Services$6,052,902ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$187,482TotalAmt
Program Services$187,482ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$10,968TotalAmt
Program Services$10,968ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$18,316TotalAmt
Program Services$18,316ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,766TotalAmt
Program Services$5,766ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$7,585TotalAmt
Program Services$7,585ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
ULTILIZATION REVIEW$51,523$51,523
PPO FEES$29,788$29,788
BANK CHARGES$13,994$13,994
ACTUARIAL$7,500$7,500

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,978TotalAmt
Program Services$4,978ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$6,390,802TotalAmt
Program Services$6,390,802ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,806,548BOYAmt
EOY$1,418,781EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$809,060BOYAmt
EOY$2,953,035EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$511,015BOYAmt
EOY$582,673EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$38,734BOYAmt
EOY$1,803EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,165,357BOYAmt
EOY$4,956,292EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$98,439BOYAmt
EOY$22,254EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$98,439BOYAmt
EOY$22,254EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,066,918BOYAmt
EOY$4,934,038EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,066,918BOYAmt
EOY$4,934,038EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,165,357BOYAmt
EOY$4,956,292EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$896,560ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$29,440NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE TPA PROVIDES A COPY OF THE 990 TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE FINAL FILING.
FORM 990, PART VI, SECTION C, LINE 19ALL DOCUMENTS ARE AVAILABLE UPON REQUEST.