2025-11-12T08:28:24-06:00 2024-12-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2024-01-01 746075997 SOUTHERN DISTRICT UBC HEALTH PLAN SOUT 8008314914 2001 CALDWELL DR GOODLETSVILLE TN 37072 KAVIN GRIFFIN CHAIRMAN 8008314914 2025-11-12 1 1 ERIN CRANMER P01712644 2023319880 2025-11-12 2024 2025-03-06 01:10:19Z X KAVIN GRIFFIN 2001 CALDWELL DR GOODLETSVILLE TN 37072 566687824 0 X N/A X 2019 TN TO PROVIDE MEDICAL BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 26 26 0 34 0 0 0 0 36023289 79333340 1122658 11858241 28463833 114443762 65609780 205635343 0 0 31616102 72786348 0 0 0 0 0 1162971 3170350 32779073 75956698 32830707 129678645 108584176 237394237 2882429 7066320 105701747 230327917 TO PROVIDE MEDICAL BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 THE PLAN PROVIDES HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS AND COVERED DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 839 0 1 0 0 0 0 0 0 0 0 0 X 26 26 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BOARD OF TRUSTEES 8008314914 2001 CALDWELL DR GOODLETSVILLE TN 37072 X KAVIN GRIFFIN CHAIRMAN - EMPLOYEE TRUSTEE 1.00 X X 0 0 0 JAMES BANKS JR EMPLOYEE TRUSTEE 1.00 X 0 0 0 MATTHEW SWANSON EMPLOYEE TRUSTEE 1.00 X 0 0 0 THOMAS H JENKINS EMPLOYEE TRUSTEE 1.00 X 0 0 0 MONTE THOMPSON EMPLOYEE TRUSTEE 1.00 X 0 0 0 DAN MORRIS EMPLOYEE TRUSTEE 1.00 X 0 0 0 BILL WARREN SECRETARY/MANAGEMENT TRUSTEE 1.00 X X 0 0 0 HAROLD BAUR III MANAGEMENT TRUSTEE 1.00 X 0 0 0 MATT MARCELLIS MANAGEMENT TRUSTEE 1.00 X 0 0 0 DAN FLETCHER MANAGEMENT TRUSTEE 1.00 X 0 0 0 JOHN HANKS MANAGEMENT TRUSTEE 1.00 X 0 0 0 RICHARD TRAVIS MANAGEMENT TRUSTEE 1.00 X 0 0 0 NEAL MCCLEARY MANAGEMENT TRUSTEE 1.00 X 0 0 0 JEFF COVERT MANAGEMENT TRUSTEE 1.00 X 0 0 0 MARK LITTLE MANAGEMENT TRUSTEE 1.00 X 0 0 0 ALEX SANDERS MANAGEMENT TRUSTEE 1.00 X 0 0 0 BOYED SANDERS MANAGEMENT TRUSTEE 1.00 X 0 0 0 MATT THOMAS MANAGEMENT TRUSTEE 1.00 X 0 0 0 DAVID W TANKERSLEY MANAGEMENT TRUSTEE 1.00 X 0 0 0 ROBERT G MOODY MANAGEMENT TRUSTEE 1.00 X 0 0 0 CHARLIE MUREEN MANAGEMENT TRUSTEE 1.00 X 0 0 0 MICHAEL B PFIEFFER MANAGEMENT TRUSTEE 1.00 X 0 0 0 LARRY S PARKS MANAGEMENT TRUSTEE 1.00 X 0 0 0 TROY VANCE MANAGEMENT TRUSTEE 1.00 X 0 0 0 PRESTON TAYLOR MANAGEMENT TRUSTEE 1.00 X 0 0 0 CONRAD VARNUM MANAGEMENT TRUSTEE 1.00 X 0 0 0 JIMMIE JORDAN MANAGEMENT TRUSTEE (UNTIL 11/12/2024) 1.00 X 0 0 0 KERRY FISHER MANAGEMENT TRUSTEE (UNTIL 1/9/2024) 1.00 X 0 0 0 MARTHA HENRICKSON EMPLOYEE TRUSTEE (UNTIL 11/12/2024) 1.00 X 0 0 0 JEREMY HUGHES EMPLOYEE TRUSTEE (UNTIL 5/16/2024) 1.00 X 0 0 0 BEAU SERPAS EMPLOYEE TRUSTEE (UNTIL 2/13/2024) 1.00 X 0 0 0 RICK HALFORD EMPLOYEE TRUSTEE (UNTIL 11/12/2024) 1.00 X 0 0 0 VICTORINO SANCHEZ EMPLOYEE TRUSTEE (UNTIL 5/16/2024) 1.00 X 0 0 0 JOHN ROBERTS EMPLOYEE TRUSTEE (UNTIL 5/16/2024) 1.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD SOUTH 1000 HOUSTON TX 77027 ACCESS AND ADMIN FEES 2997994 SOUTHERN BENEFITS ADMINISTRATORS INC 2001 CALDWELL DR GOODLETTSVILLE TN 37072 ADMINISTRATION 2102464 DISA 10900 CORPORATE CENTRE DR SUITE 25 HOUSTON TX 77041 DRUG TESTING 580464 EXPRESS SCRIPTS 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 PHARMACY ADMIN FEES 418279 THE YOUNGDAHL LAW FIRM 4302 MONTROSE BLVD SUITE 280 HOUSTON TX 77006 LEGAL SERVICES 247432 6 EMPLOYER CONTRIBUTIONS 525100 75203384 75203384 RECIPROCITY IN (OUT) 525100 3414250 3414250 PARTICIPANT CONTRIBUTIONS 525100 715706 715706 79333340 3849493 3849493 369061229 361052481 8008748 8008748 8008748 TRANSFER INCOME FROM MERGER 525100 114315978 114315978 LATE CHARGES 525100 127784 127784 114443762 205635343 193777102 0 11858241 72786348 1917000 258664 182434 265091 90730 305032 18326 29978 PCORI FEES 70992 BASIC-PLUS FEES 26910 ERISA SERVICE FEES 5193 75956698 6333455 9706757 829005 3750216 5257523 14237670 51541867 126028704 44622326 83670890 108584176 237394237 2882429 7066320 2882429 7066320 X 105701747 230327917 105701747 230327917 108584176 237394237 129678645 -5052475 0 X X 0 1 X 1 0 0 LIMITED PARNTERSHIPS 17731401 F COMMON COLLECTIVE TRUSTS 65939489 F 83670890 X 200317777 -5052475 -5052475 205370252 265091 265091 205635343 75691607 0 75691607 265091 265091 75956698 PART X, LINE 2: THE TRUST FUNDING BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISION OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE. THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE INTERNAL REVENUE CODE TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. PLAN MANAGEMENT BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. PLAN MANAGEMENT HAS EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE FOR THE YEARS ENDED DECEMBER 31, 2024 AND 2023. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. WITH FEW EXCEPTIONS, THE PLAN IS NO LONGER SUBJECT TO TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS PRECEDING DECEMBER 31, 2020. FORM 990, PART VI, SECTION B, LINE 11B TO PROVIDE MEDICAL BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS. FORM 990, PART VI, SECTION B, LINE 12C DURING BOARD OF TRUSTEE MEETINGS, TRUSTEES DISCUSS AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. 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