2021-07-12T15:38:36-05:00 2020-09-30 550621482 GRAY GRIFFITH & MAYS AC 707 VIRGINIA STREETEASTSUITE 400 CHARLESTON WV 253012711 990 2019-10-01 316068797 4TH DISTRICT IBEW HEALTH FUND 4THD 3045250331 3150 US ROUTE 60 ONA WV 25545 WILLIAM HAMILTON CHAIRMAN 3045250331 2021-07-07 1 J RYAN LINDSAY P01835061 3043459400 2019 2022-09-23 18:48:47Z WILLIAM HAMILTON 3150 US ROUTE 60 ONA WV 25545 123439924 0 X N/A X 1961 WV TO PROVIDE HEALTH AND INSURANCE BENEFITS TO MEMBERS BY PAYMENT OF CLAIMS FOR HEALTH, ACCIDENT, SICKNESS, DENTAL AND LIFE INSURANCE FOR MEMBERS AND THEIR DEPENDENTS. 8 8 0 8 0 0 0 0 71026444 73547432 3835926 1501363 0 0 74862370 75048795 0 0 67752731 74777213 0 0 0 0 0 5339735 5538941 73092466 80316154 1769904 -5267359 68094778 64671464 1751481 1332495 66343297 63338969 TO PROVIDE HEALTH AND INSURANCE BENEFITS TO MEMBERS BY PAYMENT OF CLAIMS FOR HEALTH, ACCIDENT, SICKNESS, DENTAL AND LIFE INSURANCE FOR MEMBERS AND THEIR DEPENDENTS. 0 0 74777213 TO PROVIDE HEALTH AND INSURANCE BENEFITS TO MEMBERS BY PAYMENT OF CLAIMS FOR HEALTH, ACCIDENT, SICKNESS, DENTAL AND LIFE INSURANCE FOR MEMBERS AND THEIR DEPENDENTS. 74777213 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 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 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X AMERICAN BENEFIT CORPORATION 3045250331 3150 US ROUTE 60 ONA WV 25545 X WILLIAM HAMILTON TRUSTEE 0.00 X 0 0 0 JIM GILLETTE TRUSTEE 0.00 X 0 0 0 TROY FERRELL TRUSTEE 0.00 X 0 0 0 JAMES BANE TRUSTEE 0.00 X 0 0 0 TED BRADY TRUSTEE 0.00 X 0 0 0 JOHN FRANTZ TRUSTEE 0.00 X 0 0 0 MIKE DISHON TRUSTEE 0.00 X 0 0 0 SHANE FERGUSON TRUSTEE 0.00 X 0 0 0 0 0 0 0 0 0 0 COMMUNITY INSURANCE CO DBA ANTHEM 3350 PEACHTREE ROAD POB 30302-445 ATLANTA GA 30326 CLAIMS PROCESSING 1804440 AMERICAN BENEFIT CORPORATION 3150 US ROUTE 60 ONA WV 25545 THIRD PARTY ADMINISTRATOR 1776968 AMERICAN HEALTH HOLDING 7400 W CAMPUS RD NEW ALBANY OH 43054 PRE-CERTIFICATIONS 576126 THE SEGAL COMPANY 333 W 34TH STREET NEW YORK NY 10001 ACTUARY 392301 DELTA DENTAL ONE DELTA DRIVE MECHANICSBURG PA 17055 DENTAL CLAIMS PROCESSING 288867 5 EMPLOYER CONTRIBUTIONS 525100 64944257 64944257 PARTICIPANT DIRECT PMTS 525100 7981692 7981692 MEDICARE PART D SUBSIDIES 525100 621483 621483 73547432 1057462 1057462 48835030 48391129 443901 443901 443901 75048795 73991333 0 1057462 74777213 102912 49634 249868 25573 ADMINISTRATION FEES 1809683 CLAIMS PAYING SERVICE 1804440 PRE-CERTIFICATIONS/CASE 576126 ACTUARIAL AND CONSULTIN 392301 528404 80316154 781267 1556535 7238682 7428293 46220774 42281393 13854055 13405243 68094778 64671464 1512136 1047660 239345 284835 1751481 1332495 X 0 0 0 0 66343297 63338969 66343297 63338969 68094778 64671464 -5267359 2263031 0 X X 0 1 X 1 0 0 PRIVATE COMMINGLED FUNDS 8102729 F COMMINGLED REAL ESTATE FUNDS 5302514 F 13405243 77061958 2263031 2263031 74798927 249868 249868 75048795 80066286 0 80066286 249868 249868 80316154 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES' CHAIRMAN AND SECRETARY BEFORE THEY SIGN AND FILE THE 990 FORM. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ATTEND MEETING ON FIDUCIARY RESPONSIBILITIES. THE BOARD OF TRUSTEES FUNCTIONS AS A WHOLE; NO INDIVIDUAL TRUSTEE CAN ACT ALONE. FORM 990, PART VI, SECTION C, LINE 19 THE FUND MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE FUND'S BOARD OF TRUSTEES HAS ASSUMED THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR. 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