STRATEGY STUDIO / PUBLIC DATA EXPLORER

SOUTHERN DISTRICT UBC HEALTH TRUST: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SOUTHERN DISTRICT UBC HEALTH TRUST (EIN 74-6075997)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-11
IRS object ID
201332849349301363
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-10-11T16:28:02-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN741695589EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1HARPER & PEARSON COMPANY PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE RIVERWAY SUITE 1000AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77056ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN746075997EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1TEXAS CARPENTERS AND MILLWRIGHTS HEALTHBusinessNameLine1
Business Name Line2& WELFARE FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlTEXANameControl
Phone4056822323Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 SOUTH MERIDIAN SUITE 200AddressLine1
CityOKLAHOMA CITYCity
StateOKState
ZIP Code731081751ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePAUL OLIVERName
TitleEMPLOYER TRUSTEETitle
Phone4056822323Phone
Date Signed2013-10-03DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKEVIN E BIENVENU CPAName
PTINP00079403PTIN
Phone7136222310Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPAUL OLIVERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11300 SOUTH MERIDIAN 200AddressLine1
CityOKLAHOMA CITYCity
StateOKState
ZIP Code731081751ZIPCode
FieldValueIRS element (for citing)
Gross Receipts26198005GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1960YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE MEDICAL BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13766370ProgramServiceRevenuePriorYear
Program Service Revenue CY16618986ProgramServiceRevenueCY
Investment Income Prior Year642685InvestmentIncomePriorYear
Investment Income Current Year776483InvestmentIncomeCurrentYear
Other Revenue Prior Year532791OtherRevenuePriorYear
Other Revenue Current Year1441330OtherRevenueCurrentYear
Total Revenue Prior Year14941846TotalRevenuePriorYear
Total Revenue Current Year18836799TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year13333700BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY13564589BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year545072OtherExpensePriorYear
Other Expenses Current Year135861OtherExpensesCurrentYear
Total Expenses Prior Year13878772TotalExpensesPriorYear
Total Expenses Current Year13700450TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1063074RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5136349RevenuesLessExpensesCY
Total Assets BOY18603900TotalAssetsBOY
Total Assets EOY23247723TotalAssetsEOY
Total Liabilities BOY9885299TotalLiabilitiesBOY
Total Liabilities EOY9392773TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8718601NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13854950NetAssetsOrFundBalancesEOY
Mission DescriptionPROVISION OF HEALTH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense13700450Expense
Revenue18836799Revenue
DescriptionPROVISION OF HEALTH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.Description
Total Program Service Expense13700450TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BOARD OF TRUSTEESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4056822323TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11300 SOUTH MERIDIAN SUITE 200AddressLine1
CityOKLAHOMA CITYCity
StateOKState
ZIP Code731081751ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JASON ENGLES
SECRETARY2.00X000
JAMES SCHWINKEN
EMPLOYER TRUSTEE2.00X000
MARCO VARGAS
UNION TRUSTEE2.00X000
DAVID BONDS
UNION TRUSTEE2.00X000
MICHAEL BREDA
EMPLOYER TRUSTEE2.00X000
STEVE LUEBBEHUSE
EMPLOYER TRUSTEE2.00X000
RICHARD TRAVIS
EMPLOYER TRUSTEE2.00X000
MIKE HINES
UNION TRUSTEE2.00X000
DAVID WETMORE
UNION TRUSTEE2.00X000
KENNETH FONTENOR
UNION TRUSTEE2.00X000
PAT KILEY
EMPLOYER TRUSTEE2.00X000
PAUL OLIVER
CHAIRMAN2.00X000
JOHN HANKS
EMPLOYER TRUSTEE2.00X000
DONNIE HOOPER
UNION TRUSTEE2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BLUE CROSS BLUE SHIELD
2425 WEST LOOP SOUTH 1000HOUSTONTX77027CLAIMS PROCESSING755338
ZENITH ADMINISTRATORS
9555 W SAM HOUSTON PKWY 400HOUSTONTX77099ADMINISTRATION429391
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS9000991611392916113929
PARTICIPANT CONTRIBUTIONS900099505057505057
FieldValueIRS element (for citing)
Total Program Service Revenue16618986TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column834583TotalRevenueColumn
Related Or Exempt Function Income834583RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities7303106Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities7361206Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-58100Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-58100TotalRevenueColumn
Related Or Exempt Function Income-58100RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
UNREALIZED GAINS90009913876251387625
OTHER INCOME9000995370553705
FieldValueIRS element (for citing)
Total Other Revenue1441330TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18836799TotalRevenueColumn
Related Or Exempt Function Income18836799RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total13564589Total
Program Services13564589ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total57038Total
Program Services57038ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total39971Total
Program Services39971ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total53409Total
Program Services53409ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
ADMINISTRATION FEES429391429391
OTHER7598475984
CONSULTING FEES2890028900
CLAIMS LIABILITY ESTIMA-548832-548832

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13700450Total
Program Services13700450ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY189177BOY
EOY439775EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1562543BOY
EOY1149802EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY16852180BOY
EOY21658146EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY18603900BOY
EOY23247723EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1166128BOY
EOY1222434EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8719171BOY
EOY8170339EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9885299BOY
EOY9392773EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8718601BOY
EOY13854950EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18603900BOY
EOY23247723EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses5136349ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CLAIMS IBNR$2,067,137
BANK LIABILITY$6,103,202
FieldValueIRS element (for citing)
Total Of Amounts8170339TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt18836799TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal18836799RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99018836799TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13700450TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal13700450ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013700450TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO IT BEING SIGNED AND FILED.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST POLICY IS SIGNED BY ALL TRUSTEES & INTERESTED PARTIES. MONITORING AND ENFORCEMENT IS AN ONGOING PROCESS REVIEWED AT ALL BOARD MEETINGS.
FORM 990, PART VI, SECTION C, LINE 19FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND IS AVAILABLE FOR PUBLIC INSPECTION THROUGH THE AGENCY OR WRITTEN REQUESTS TO THE BOARD OF TRUSTEES.
FORM 990, PART XI, LINE 2CTHE COMMITTEE DID NOT CHANGE ITS OVERSIGHT PROCESS DURING THE TAX YEAR