2020-07-15T13:44:23-05:00 2019-09-30 550621482 GRAY GRIFFITH & MAYS AC 707 VIRGINIA STREETEASTSUITE 400 CHARLESTON WV 253012711 990 2018-10-01 316068797 4TH DISTRICT IBEW HEALTH FUND 4THD 3045250331 3150 US ROUTE 60 ONA WV 25545 WILLIAM HAMILTON CHAIRMAN 3045250331 2020-07-14 1 J RYAN LINDSAY P01835061 3043459400 207.192.238.246 2020-07-14 16:24:03 ED P 9817086D0D4943BBAEE1DD1F650EF854B2A0276C 2A42D5B810A26303AF86E43B557A4BC7F00C6769 2018 2021-09-10 13:11:23Z WILLIAM HAMILTON 3150 US ROUTE 60 ONA WV 25545 150609116 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 62329036 71026444 2457249 3835926 0 0 64786285 74862370 0 0 57268482 67752731 0 0 0 0 0 4687236 5339735 61955718 73092466 2830567 1769904 66824427 68094778 1328106 1751481 65496321 66343297 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 67752731 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. 67752731 0 0 0 0 0 0 0 0 0 0 0 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 6 0 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 AMERICAN BENEFIT CORPORATION 3150 US ROUTE 60 ONA WV 25545 THIRD PARTY ADMINISTRATOR 1793985 COMMUNITY INSURANCE CO DBA ANTHEM 3350 PEACHTREE ROAD POB 30302-445 ATLANTA GA 30326 CLAIMS PROCESSING 1732997 THE SEGAL COMPANY 333 W 34TH STREET NEW YORK NY 10001 ACTUARY 407126 INNOVATIVE HEALTHCARE DELIVERY LLC 3540 W SAHARA AVE 444 LAS VEGAS NV 89102 TRANSITION CARE 164787 LEDBETTER PARISI SOLLARS LLC 9240 MARKETPLACE DRIVE MIAMISBURG OH 45342 ATTORNEY 107533 5 EMPLOYER CONTRIBUTIONS 525100 63047211 63047211 PARTICIPANT DIRECT PMTS 525100 7503176 7503176 MEDICARE PART D SUBSIDIES 525100 476057 476057 71026444 1420788 1420788 78161884 75746746 2415138 2415138 2415138 74862370 73441582 0 1420788 67752731 107533 52851 270568 30370 ADMINISTRATION FEES 1793985 CLAIMS PAYING SERVICE 1732997 PRE-CERTIFICATIONS/CASE 489102 ACTUARIAL AND CONSULTIN 407126 455203 73092466 417070 781267 7222928 7238682 59184429 60074829 66824427 68094778 1059888 1512136 268218 239345 1328106 1751481 X 0 0 0 0 65496321 66343297 65496321 66343297 66824427 68094778 1769904 -922928 0 X X 0 1 X 1 0 0 73668874 -922928 -922928 74591802 270568 270568 74862370 72821898 0 72821898 270568 270568 73092466 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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