2018-05-15T14:18:22-05:00 2017-06-30 621142155 PUGH & COMPANY PC 315 N CEDAR BLUFF RD SUITE 200 KNOXVILLE TN 37923 990 2016-07-01 621238720 THE HT HACKNEY CO VEBA HTHA 8655461291 502 S GAY STREET KNOXVILLE TN 379021503 MICHAEL MORTON VICE PRESIDENT 8655461291 2018-05-15 1 SUSAN R FOARD CPA P00745361 8657690660 2016 2022-09-23 18:48:47Z MICHAEL MORTON 502 S GAY STREET KNOXVILLE TN 379021503 20612129 0 X N/A X 1984 TN PROVIDE HEALTH CARE BENEFITS FOR THE EMPLOYEES OF THE H. T. HACKNEY CO. 1 1 0 0 0 0 0 0 20235472 20600343 3011 11786 0 0 20238483 20612129 0 0 16863813 16696910 0 0 0 0 0 3145486 3234288 20009299 19931198 229184 680931 5492974 6602054 1114399 1542548 4378575 5059506 NONE 0 0 19503049 PROVIDE SELF-FUNDED HEALTH CARE BENEFITS TO EMPLOYEES & FORMER EMPLOYEES AND THEIR DEPENDENTS. CLAIMS ARE PROCESSED BY A THIRD PARTY ADMINISTRATOR AND COINSURANCE IS MAINTAINED FOR CLAIMS EXCEEDING $150,000. 19503049 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 0 0 0 1 1 0 0 0 0 0 X 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 X MIKE MORTON 8655461291 502 S GAY STREET KNOXVILLE TN 379021503 MIKE MORTON COMM MEMBER 2.00 X 0 0 0 REGIONS BANK TRUSTEE/ ASSET MANAGER 1.00 X 1050 0 0 1050 0 0 0 0 0 0 UNITED HEALTHCARE 10 CADILLAC DRIVE - SUITE 100 BRENTWOOD TN 37027 TO PROVIDE HEALTHCARE PAYMENTS. 1095765 1 EMPLOYER 525100 13210239 13210239 EMPLOYEE 525100 7390104 7390104 20600343 11786 11786 20612129 20600343 0 11786 16696910 STOP LOSS PREMIUMS 2052222 CLAIMS ADMINISTRATION E 1095765 ACA REINSURANCE FEES 86301 19931198 372983 350508 4325476 4599739 794515 1651807 5492974 6602054 1114399 1542548 1114399 1542548 X 0 0 0 0 4378575 5059506 4378575 5059506 5492974 6602054 680931 0 X 0 1 X 0 0 0 X 20612129 0 20612129 0 20612129 19931198 0 19931198 0 19931198 PART X, LINE 2: THE TRUST IS EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)9 OF THE INTERNAL REVENUE CODE (IRC) AND ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. IN ADDITION, THE BENEFIT PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI STATEMENT REGARDING OVERALL GOVERNING BODY AND MANAGEMENT FUNCTIONS: THE TAXPAYER IS A VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION (THE "TRUST") WHOSE SOLE PURPOSE IS TO RECEIVE CONTRIBUTIONS AND MAKE DISBURSEMENTS PURSUANT TO THE H.T. HACKNEY COMPANY FLEXIBLE BENEFITS PLAN (THE "PLAN"). THE PLAN IS A WELFARE BENEFIT PLAN SUBJECT TO ERISA THAT PROVIDES HEALTH CARE BENEFITS FOR ALL ELIGIBLE EMPLOYEES OF THE H.T. HACKNEY COMPANY (THE "SPONSOR") AND IS FUNDED IN PART BY EMPLOYEE CONTRIBUTIONS AND IN PART FROM THE GENERAL ASSETS OF SPONSOR WHOSE PAYMENTS ALSO FLOW THROUGH THE TRUST. UNITED HEALTHCARE ADMINISTERS THE PLAN. EMPLOYEE PREMIUMS ARE DEDUCTED FROM EMPLOYEE EARNINGS EACH PAYDAY AND A CHECK OR ACH FOR TOTAL EMPLOYEE PREMIUMS AND EMPLOYER CONTRIBUTIONS IS THEN FORWARDED TO THE REGIONS BANK TRUST DEPARTMENT FROM BENEFITS ADMINISTRATOR FOR CREDITING TO THE TRUST'S ACCOUNT. EMPLOYER'S CONTRIBUTION IS CALCULATED MONTHLY, BASED ON THE TARGET AMOUNT THAT IS DETERMINED ANNUALLY, AND FORWARDED TO THE TRUST DEPARTMENT, AS WELL. REGIONS BANK'S TRUST DEPARTMENT INVESTS THE FUNDS IN MONEY MARKET INSTRUMENTS. CLAIM INVOICES ARE RECEIVED FROM UNITED HEALTHCARE WEEKLY AND A REQUEST FOR FUNDS TRANSFER TO THE PLAN'S CHECKING ACCOUNT IS SUBMITTED TO THE TRUST DEPARTMENT BY THE BENEFITS ADMINISTRATOR FOR PAYMENT OF CLAIMS. THE TRUST DEPARTMENT PROVIDES MONTHLY STATEMENTS TO THE PLAN ADMINISTRATOR. PART VI CONTAINS SEVERAL QUESTIONS THAT ARE EITHER INAPPLICABLE TO THE TRUST OR THAT ARE ANSWERED DIFFERENTLY FROM OTHER TYPES OF TAX-EXEMPT ORGANIZATIONS, SPECIFICALLY: NO. 3 - THE PLAN ADMINISTRATOR HAS DELEGATED THE MANAGEMENT AND INVESTMENT OF ITS ASSETS TO THE TRUST DEPARTMENT OF REGIONS BANK. NO. 8 - ALL ACTIONS TAKEN BY THE TRUST ARE WELL DOCUMENTED BY PLAN ADMINISTRATOR AND AN OUTSIDE AGENCY BUT THERE ARE NO MEETINGS AND DOCUMENT ACTIONS WITH RESPECT TO THE TRUST. NO. 11 - THE FORM 990 IS REVIEWED BY THE BENEFITS ADMINISTRATOR AND THE CFO OR SPONSOR. NO. 12 - THE TRUST DOES NOT HAVE A WRITTEN CONFLICT OF INTEREST POLICY. UNITED HEALTHCARE FOLLOWS THE BENEFITS PLAN DOCUMENTS AND THERE ARE NO POTENTIAL CONFLICTS OF INTEREST. ANY APPEALS ARE REVIEWED BY UNITED HEALTHCARE REGARDLESS OF WHO IT IS. NO. 14 - THE SPONSOR DOES NOT HAVE AN ESTABLISHED DOCUMENT RETENTION AND DESTRUCTION POLICY. NO. 15 - THIS IS NOT APPLICABLE. THE TRUST DOES NOT HAVE EMPLOYEES AND DOES NOT COMPENSATE DIRECTLY OR INDIRECTLY ANY EMPLOYEES OF EMPLOYER. NO. 19 - THE PLAN AND THE SPONSOR PROVIDE INFORMATION TO PLAN PARTICIPANTS AS REQUIRED BY ERISA AND THE DEPARTMENT OF LABOR. THE TRUST HAS NOT MADE GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AND THE TRUST DOES NOT MAINTAIN A CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION A, LINE 8A INCLUDED IN DISCUSSION ABOVE. FORM 990, PART VI, SECTION A, LINE 8B INCLUDED IN DISCUSSION ABOVE. FORM 990, PART VI, SECTION B, LINE 11B INCLUDED IN DISCUSSION ABOVE. FORM 990, PART VI, SECTION C, LINE 19 INCLUDED IN DISCUSSION ABOVE. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC REGIONS BANK - 151 MAJOR REYNOLDS PLACE, KNOXVILLE, TN 37919. THE HT HACKNEY CO 502 SOUTH GAY STREET KNOXVILLE TN 37901 620222535 WHOLESALE SALES TN C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 THE HT HACKNEY CO (EMPLOYER CONTRIBUTIONS) S 13210239 CASH - FMV