STRATEGY STUDIO / PUBLIC DATA EXPLORER

DAVIDSON HOTEL COMPANY HEALTH CARE TRUST: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
DAVIDSON HOTEL COMPANY HEALTH CARE TRUST (EIN 62-6176418)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-06
IRS object ID
201343109349301659
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)
Timestamp2013-11-06T15:13:43-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1999 S SHADY GROVE RD STE 400AddressLine1
CityMEMPHISCity
StateTNState
ZIP Code38120ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN626176418EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1DAVIDSON HOTEL COMPANY EMPLOYEE HEALTH CARE TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlDAVINameControl
Phone6783490909Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE RAVINA DRIVE NO 1600AddressLine1
CityATLANTACity
StateGAState
ZIP Code30346ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLARRY M MILLSName
TitleVP FINANCETitle
Phone6783490909Phone
Date Signed2013-11-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN A MAY JRName
PTINP00210965PTIN
Phone9017613000Phone
Date Prepared2013-11-04DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonLARRY M MILLSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1ONE RAVINA DRIVE NO 1600AddressLine1
CityATLANTACity
StateGAState
ZIP Code30346ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23381392GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1983YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionVOLUNTARY EMPLOYEE BENEFIT ASSOCIATION - A PROGRAM TO PROVIDE COMPREHENSIVE HEALTH CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body0NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
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 Year23352926ProgramServiceRevenuePriorYear
Program Service Revenue CY23381392ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year23352926TotalRevenuePriorYear
Total Revenue Current Year23381392TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year2299427BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY2633322BenefitsPaidToMembersCY
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 Year18947492OtherExpensePriorYear
Other Expenses Current Year20006619OtherExpensesCurrentYear
Total Expenses Prior Year21246919TotalExpensesPriorYear
Total Expenses Current Year22639941TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2106007RevenuesLessExpensesPriorYear
Revenues Less Expenses CY741451RevenuesLessExpensesCY
Total Assets BOY9538960TotalAssetsBOY
Total Assets EOY10376246TotalAssetsEOY
Total Liabilities BOY185635TotalLiabilitiesBOY
Total Liabilities EOY281470TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY9353325NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10094776NetAssetsOrFundBalancesEOY
Mission DescriptionVOLUNTARY EMPLOYEE BENEFIT ASSOCIATION - A PROGRAM TO PROVIDE COMPREHENSIVE HEALTH CARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionVOLUNTARY EMPLOYEE BENEFIT ASSOCIATION - A PROGRAM TO PROVIDE COMPREHENSIVE HEALTH CARE AND SHORT TERM DISABILITY, LONG-TERM DISABILITY, AND LIFE BENEFITS TO QUALIFIED EMPLOYEES AND DEPENDENTSDescription
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 Liabilities0ReportOtherLiabilities
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 Required1ScheduleJRequired
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 Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
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 Members0NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
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 Body0MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledTNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BRENDA DAVIS-SMITHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6783490909TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1ONE RAVINA DRIVE SUITE 1600AddressLine1
CityATLANTACity
StateGAState
ZIP Code30346ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (2 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
MARK FRENCH
TRUSTEE5.00X03297950
LARRY MILLS
VP FINANCE5.0002912280X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs621023TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AETNA
151 FARMINGTON AVEHARTFORDCT06156ADMINISTRATIVE FEES1263467
MC & H LIFE AGENCY INC
8144 WALNUT HILL LANESTE 1600DALLASTX75231CONSULTING FEES250000
MATRIX ABSENCE MANAGEMENT INC
181 METRO DRIVE SUITE 300SAN JOSECA95110ADMINISTRATIVE FEES149540
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionEMPLOYER/EMPLOYEE CONTRIBUTIONSDescription
Business Code525100BusinessCode
Total Revenue Column23381392TotalRevenueColumn
Related Or Exempt Function Income23381392RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue23381392TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23381392TotalRevenueColumn
Related Or Exempt Function Income23381392RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total2633322Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
CLAIMS PAID FOR PARTICI18117234
ADMINISTRATIVE EXPENSES1889385

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22639941Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY8203880BOY
EOY8748475EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1335080BOY
EOY1627771EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9538960BOY
EOY10376246EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY185635BOY
EOY281470EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY185635BOY
EOY281470EOY
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)
BOY9353325BOY
EOY10094776EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9353325BOY
EOY10094776EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9538960BOY
EOY10376246EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses741451ReconcilationRevenueExpenses
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
Tot Revenue Etc Audited Fincl Stmt23381392TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal23381392RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99023381392TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt22639941TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal22639941ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022639941TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK FRENCH
TRUSTEE032979500000000032979500
LARRY MILLS
VP FINANCE029122800000000029122800

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
LARRY MILLS
TRUSTEEMR. MILLS IS EMPLOYED BY THE PLAN SPONSOR AND HE SERVES AS A TRUSTEE OF THE PLAN.0
MARK FRENCH
TRUSTEEMR. FRENCH IS EMPLOYED BY THE PLAN SPONSOR AND HE SERVES AS A TRUSTEE OF THE PLAN.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2THE TWO BOARD MEMBERS ALSO SERVE AS OFFICERS OF ANOTHER BUSINESS.
FORM 990, PART VI, SECTION A, LINE 8ADAVIDSON HOTEL COMPANY EMPLOYEE HEALTH CARE TRUST IS A TRUST; ALL MEETINGS ARE HELD AT CORPORATE LEVEL.
FORM 990, PART VI, SECTION A, LINE 8BDAVIDSON HOTEL COMPANY EMPLOYEE HEALTH CARE TRUST IS A TRUST; ALL MEETINGS ARE HELD AT CORPORATE LEVEL.
FORM 990, PART VI, SECTION B, LINE 11A COPY OF THE 990 DRAFT WAS PROVIDED TO THE TRUSTEES PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION C, LINE 19ALL DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990,L PART XI, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.COMMITTEE THAT OVERSEES AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT:

Schedule R IRS990ScheduleR

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1DAVIDSON HOTEL CO LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13340 PLAYERS CLUB PARKWAY SUITE 200AddressLine1
CityMEMPHISCity
StateTNState
ZIP Code38125ZIPCode
FieldValueIRS element (for citing)
EIN626176418EIN
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

FieldValueIRS element (for citing)
Transaction TypeOTransactionType