2019-06-28T14:29:44-05:00 2018-09-30 550621482 GRAY GRIFFITH & MAYS AC 707 VIRGINIA STREETEASTSUITE 400 CHARLESTON WV 253012711 990 2017-10-01 316068797 4TH DISTRICT IBEW HEALTH FUND 4THD 3045250331 3150 US ROUTE 60 ONA WV 25545 WILLIAM HAMILTON CHAIRMAN 3045250331 2019-06-28 1 J RYAN LINDSAY P01835061 3043459400 207.192.238.246 2019-06-28 15:01:25 ED P 00BF474690C9102C28DD285F66C0EF42F850EDF8 F09B26861C37D5444EFEB8A331BD3EB34C18B9EC 2017 2020-03-31 21:24:44Z WILLIAM HAMILTON 3150 US ROUTE 60 ONA WV 25545 71987209 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 0 0 0 0 0 52524032 62329036 2444100 2457249 0 0 54968132 64786285 0 0 52685493 57268482 0 0 0 0 0 4190423 4687236 56875916 61955718 -1907784 2830567 64514656 66824427 1663195 1328106 62851461 65496321 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 57268482 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. 57268482 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 8 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 DANA JOE SAMPLES EMPLOYEE TRUSTEE 0.00 X 0 0 0 WILLIAM HAMILTON EMPLOYEE TRUSTEE/CHAIRMAN 0.00 X 0 0 0 JIM GILLETTE EMPLOYEE TRUSTEE 0.00 X 0 0 0 TROY FERRELL EMPLOYEE TRUSTEE 0.00 X 0 0 0 JAMES BANE EMPLOYER TRUSTEE 0.00 X 0 0 0 TED BRADY EMPLOYER TRUSTEE/SECRETARY 0.00 X 0 0 0 JOHN FRANTZ EMPLOYER TRUSTEE 0.00 X 0 0 0 CURTIS EVANS EMPLOYER 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 1545871 COMMUNITY INSURANCE CO DBA ANTHEM 3350 PEACHTREE ROAD POB 30302-445 ATLANTA GA 30326 CLAIMS PROCESSING 1544137 THE SEGAL COMPANY 333 W 34TH STREET NEW YORK NY 10001 ACTUARY 355028 INNOVATIVE HEALTHCARE DELIVERY LLC 3540 W SAHARA AVE 444 LAS VEGAS NV 89102 TRANSITION CARE 168062 LEDBETTER PARISI SOLLARS LLC 9240 MARKETPLACE DRIVE MIAMISBURG OH 45342 ATTORNEY 135739 5 EMPLOYER CONTRIBUTIONS 525100 53851953 53851953 PARTICIPANT DIRECT PMTS 525100 7769664 7769664 MEDICARE PART D SUBSIDIES 525100 707419 707419 62329036 1092893 1092893 8565280 7200924 1364356 1364356 1364356 64786285 62329036 0 2457249 57268482 108412 68175 216824 35954 ADMINISTRATION FEES 1565414 CLAIMS PAYING SERVICE 1544137 PRE-CERTIFICATIONS/CASE 472766 ACTUARIAL AND CONSULTIN 355028 320526 61955718 417070 5604377 7222928 58910279 59184429 64514656 66824427 1420287 1059888 242908 268218 1663195 1328106 X 0 0 0 0 62851461 65496321 62851461 65496321 64514656 66824427 2830567 -185707 0 X X 0 1 X 1 0 0 64383754 -185707 -185707 64569461 216824 216824 64786285 61738894 0 61738894 216824 216824 61955718 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 ACCOUNTANT. 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