2017-04-17T09:58:48-05:00 2016-09-30 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS RD STE 1500 RALEIGH NC 27609 990 2015-10-01 566595155 NORTH CAROLINA BAR ASSOCIATION HEALTH BENEFIT TRUST NORT 9196778900 8000 WESTON PARKWAY NO 200 CARY NC 27513 ELIZABETH W VOLTZ TRUST CHAIR 9196778900 2017-04-17 1 JOHN HUSKINS P01081531 9197196400 2017-04-17 2015 2021-01-29 14:40:06Z ELIZABETH W VOLTZ 8000 WESTON PARKWAY NO 200 CARY NC 27513 47166794 0 X N/A X 2002 NC MULTIPLE EMPLOYER WELFARE ARRANGEMENT 5 5 0 0 0 0 0 0 32470725 34900406 275998 437737 1121127 1294821 33867850 36632964 0 0 31044634 32006416 6400 6300 0 0 0 4658054 4581319 35709088 36594035 -1841238 38929 15219532 14916209 4062306 3621739 11157226 11294470 THE TRUST IS A HEALTH BENEFIT PROGRAM WHEREBY AN EMPLOYEE OF A PARTICIPATING EMPLOYER, UPON EMPLOYMENT, MAY ELECT COVERAGE. 0 0 THE TRUST IS A SELF-FUNDED MULTIPLE-EMPLOYER WELFARE PLAN, OPERATED SOLELY AND EXCLUSIVELY AS A NON-PROFIT ENTITY FOR THE PURPOSE OF PROVIDING BENEFITS TO EMPLOYEES OF PARTICIPATING EMPLOYERS. THE NUMBER OF PARTICIPANTS AT 9/30/16 IS 3,696. 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 7 0 1 0 1 1 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X ERIN O ORR 9196778900 8000 WESTON PARKWAY CARY NC 27513 ELIZABETH W VOLTZ TRUST CHAIR 1.00 X 1400 0 0 MICHELLE L FRAZIER TRUST SECRETARY 1.00 X 700 0 0 M ANN ANDERSON TRUSTEE 1.00 X 1400 0 0 RALPH W MEEKINS TRUSTEE 1.00 X 1050 0 0 PHILIP R MILLER TRUSTEE 1.00 X 1400 0 0 5950 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD OF NORTH CAROLINA 5901 CHAPEL HILL RD DURHAM NC 27707 ADMINISTRATIVE SERVICES 2274016 LAWYERS INSURANCE AGENCY 8000 WESTON PARKWAY SUITE 200 CARY NC 27513 ADMINISTRATIVE SERVICES 1429018 BUSINESSOLVER 1025 ASHWORTH RD STE 101 WEST DES MOINES IA 50265 SOFTWARE SERVICES 159670 EXPRESS SCRIPTS 1 EXPRESS WAY ST LOUIS MO 63121 ADMINISTRATIVE SERVICES 104011 4 PREMIUMS EARNED 900099 34900406 34900406 34900406 239578 239578 10731989 10533830 198159 198159 198159 REBATES EARNED 900099 1294821 1294821 1294821 36632964 34900406 0 1732558 32006416 6300 1592601 4818 32050 33478 2436843 6090 140034 2645 74752 TAXES, LICENSES, AND FE 258008 36594035 1507196 3092524 96997 227595 77789 54140 12281739 9528441 1255811 2013509 15219532 14916209 662751 585983 138268 740092 3261287 2295664 4062306 3621739 X 0 0 0 0 11157226 11294470 11157226 11294470 15219532 14916209 38929 98315 0 X 0 1 X 1 0 0 REINS. RECOV & COLLECTED PREM. 944346 PHARMACY REBATES RECEIVABLE 619908 INVESTMENT INCOME RECEIVABLE 29994 TAXES RECEIVABLE 78310 FUNDS HELD ON DEPOSIT 340951 2013509 HEALTH CLAIMS LIABILITY 2295664 2295664 X 36676960 43996 43996 36632964 0 36632964 36570386 0 36570386 23649 23649 36594035 PART X, LINE 2: THE SPONSOR ANALYZED THE TAX POSITIONS TAKEN BY THE TRUST, AND CONCLUDED THAT AS OF SEPTEMBER 30, 2016 AND 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: STAT TO GAAP - CHANGE IN NON-ADMITS 23,649. NORTH CAROLINA BAR ASSOCIATION VEBA SPONSOR 0 FORM 990, PART VI, SECTION B, LINE 11 THE TRUST CHAIR REVIEWS AND SIGNS THE FORM 990 ONE WEEK PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 15 THE TRUSTEES RECEIVE AGREED UPON FEES BASED ON THEIR ATTENDANCE AT TRUSTEE MEETINGS THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 ALL FINANCIAL INFORMATION IS CURRENTLY ON FILE WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE FOR PUBLIC REVIEW. 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