2024-07-31T11:39:16-05:00 2022-12-31 882730877 CHERRY BEKAERT ADVISORY LLC 3800 GLENWOOD AVE SUITE 200 RALEIGH NC 27612 990 2022-01-01 856586606 INDEPENDENT CARE HEALTH BENEFIT TRUST INDE 8554463227 110 DONMOOR COURT GARNER NC 27529 CHRISTOPHER C WOODFIN TRUSTEE 8554463227 2024-07-31 1 1 PAULA WENDLING P00536805 9197821040 2022 2024-08-08 14:25:15Z X X CHRISTOPHER C WOODFIN 110 DONMOOR COURT GARNER NC 27529 8591721 0 X INDEPENDENTCARETRUST.ORG X 2021 NC THE ORGANIZATION IS A MULTIPLE EMPLOYER WELFARE ARRANGEMENT (MEWA) WHICH PROVIDES MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR ITS MEMBERS AND THEIR DEPENDENTS. 4 1 0 2 0 0 0 0 0 8591721 0 0 0 0 0 8591721 0 0 0 7142645 0 0 0 0 0 0 1153551 0 8296196 0 295525 0 4657865 0 4362340 0 295525 THE ORGANIZATION IS A MULTIPLE EMPLOYER WELFARE ARRANGEMENT (MEWA) WHICH PROVIDES MEDICAL AND PRESCRIPTION DRUG BENEFITS FOR ITS MEMBERS AND THEIR DEPENDENTS. 0 0 ALL FUNDS ARE USED FOR THE PURPOSE OF PROVIDING BENEFITS TO MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 NC X COLIN FELMET 9197452442 110 DONMOOR COURT GARNER NC 27529 L ALLEN DOBSON JR TRUSTEE 0.50 X 0 0 0 CONRAD FLICK TRUSTEE 0.50 39.50 X 0 108000 0 JOSEPH MOOSE TRUSTEE 0.50 X 0 0 0 CHRISTOPHER WOODFIN TRUSTEE 0.50 39.50 X 0 522463 40930 0 630463 40930 0 0 1 0 HEALTHCOMP 2100 COVINGTON CENTRE SUITE B COVINGTON LA 70434 THIRD PARTY ADMINISTRATOR 336342 VIMLY BENEFIT SOLUTIONS 12121 HARBOUR REACH DR STE 105 MUKILTEO WA 98275 BENEFITS CONSULTING 160172 2 MEDICAL PREMIUMS 900099 8591721 8591721 8591721 8591721 8591721 0 0 7142645 285 758262 79375 314869 BANK FEES 760 8296196 3730181 927684 0 4657865 282965 0 4079375 0 4362340 X 0 0 0 0 0 295525 0 295525 0 4657865 295525 0 X 0 1 X 1 0 0 RELATED PARTY PROMISSORY NOTES & INTEREST PAYABLE 4079375 4079375 X 9686998 698053 397224 1095277 8591721 0 8591721 10564473 698053 1173000 1871053 8693420 -397224 -397224 8296196 PART X, LINE 2: THE TRUST IS IN THE PROCESS OF SUBMITTING ITS EXEMPT APPLICATION AND, THEREFORE, THE INTERNAL REVENUE SERVICE ("IRS") HAS NOT STARTED ITS REVIEW THAT THE TRUST IS DESIGNED IN ACCORDANCE WITH THE APPLICABLE SECTIONS OF THE INTERNAL REVENUE CODE ("IRC"). HOWEVER, THE SPONSOR BELIEVES THE TRUST, AS DESIGNED, MEETS THE REQUIREMENTS OF SECTION 501(C)(9) OF THE IRC AND IS EXEMPT FROM INCOME TAX UNDER SECTION 501(A) OF THE IRC OF 1986. INVESTMENT INCOME, WHEN PRESENT, THAT EXCEEDS THE "SET ASIDE" AMOUNT IS SPECIFICALLY TAXABLE AS UNRELATED BUSINESS INCOME. THE TRUST DID NOT HAVE ANY UNRELATED BUSINESS INCOME FOR THE YEAR ENDED DECEMBER 31, 2022 OR THE PERIOD FROM INCEPTION (OCTOBER 1, 2021) THROUGH DECEMBER 31, 2021. U.S. GAAP REQUIRES TRUST MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE TRUST HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE TRUST IS SUBJECT TO AUDIT BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: STOP-LOSS INSURANCE REBATES 397,224. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS 1,173,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: STOP-LOSS INSURANCE REBATES -397,224. 0 0 0 CHRISTOPHER WOODFIN TRUSTEE 0 397099 0 124137 0 1227 0 15250 0 25680 0 563393 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT DUTIES ARE PERFORMED BY THE SPONSORING ORGANIZATION, COMMUNITY CARE OF NORTH CAROLINA AND SUBSIDIARIES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO SUCH COMMITTEES REQUIRING MINUTES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO MEMBERS OF THE BOARD FOR APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES RECEIVE ANNUAL TRAINING ON THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. ANY POTENTIAL CONFLICTS ARE NOTED IN THE MINUTES OF THE MEETING IN WHICH THE CONFLICT ARISES. THE RECORDS ARE REVIEWED ANNUALLY TO ENSURE COMPLIANCE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS MAY BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. COMMUNITY CARE OF NORTH CAROLINA INC 110 DONMOOR CT GARNER NC 27529 463355510 BUILD AND SUPPORT COMMUNITY BASED HEALTHCARE SYSTEMS NC 501(C)(3) LINE 7 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1