2024-10-03T09:57:02-05:00 2023-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS RD STE 1500 RALEIGH NC 27609 990 2023-01-01 562096193 NORTH CAROLINA MEDICAL SOCIETY EMPLOYEE BENEFIT TRUST NORT 9198787502 700 SPRING FOREST ROAD 400 RALEIGH NC 27609 KENNETH HOLT CHAIRMAN 9198787502 2024-10-02 1 0 J CALVIN MARKS P01226973 9197196400 2023 2024-10-15 13:58:12Z DR KENNETH A HOLT MD 700 SPRING FOREST ROAD 400 RALEIGH NC 27609 54038402 0 X WWW.NCMSPLAN.COM X 1998 NC THE TRUST IS A FUNDING MECHANISM FOR A MULTIPLE EMPLOYER WELFARE ARRANGEMENT. MEMBERS OF THE NORTH CAROLINA MEDICAL SOCIETY, THEIR EMPLOYEES, AND DEPEDENTS ARE ELIGIBLE TO ENROLL FOR THE HEALTH, DENTAL, AND LIFE BENEFITS OFFERED. 4 4 0 0 0 0 0 0 48262826 44479035 740060 687399 0 0 49002886 45166434 141000 113600 44501377 42223384 10000 8000 0 0 0 6701999 6877933 51354376 49222917 -2351490 -4056483 33134903 29038709 4798700 4335285 28336203 24703424 X THE NORTH CAROLINA MEDICAL SOCIETY EMPLOYEE BENEFIT PLAN PROVIDES NORTH CAROLINA PHYSICIANS WITH A VALUE-ADDED PLAN THAT IS STRAIGHTFORWARD AND SPECIFICALLY CUSTOMIZED TO MEET THEIR PRACTICE AND EMPLOYEES' NEEDS. AS THE ONLY STATEWIDE HEALTH BENEFITS PLAN DESIGNED EXCLUSIVELY FOR NORTH CAROLINA PHYSICIANS, THE NCMS PLAN OFFERS CHOICES THAT ARE UNIQUE TO THE MARKET. 0 0 THE TRUST PROVIDES HEALTH, DENTAL, AND LIFE INSURANCE BENEFITS TO ELIGIBLE MEMBERS OF THE NORTH CAROLINA MEDICAL SOCIETY AND THEIR EMPLOYEES. 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 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 8 0 1 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 X STEVEN SAWYER CO MEDICAL MUTUAL INSURANCE CO OF NC 9198787502 700 SPRING FOREST ROAD 400 RALEIGH NC 27609 KENNETH A HOLT MD CHAIR 2.00 X X 4000 0 0 SANDY COHEN MD TRUSTEE 1.00 X 1500 0 0 WILLIAM INGRAM III MD TRUSTEE 1.00 X 1500 0 0 MARY ANN CONTAGIANNIS MD TRUSTEE 1.00 X 1000 0 0 8000 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD OF NC PO BOX 580086 CHARLOTTE NC 28258 CLAIMS ADJUDICATION & ADMINISTRATION 2405239 SENTINEL BENEFIT CONSULTING 4700 SIX FORKS RD SUITE 200 RALEIGH NC 27609 SALES & MARKETING 1980366 MEDICAL MUTUAL INSURANCE CO OF NC 700 SPRING FOREST RD SUITE 400 RALEIGH NC 27609 MANAGEMENT & ADMINISTRATION 1414743 CRUM & FORSTERNORTH RIVER INSURANCE 5 CHRISTOPHER WAY 2ND FLOOR EATONTOWN NJ 07724 STOP LOSS COVERAGE 836183 NC MEDICAL SOCIETY PO BOX 27167 RALEIGH NC 27611 PLAN SPONSORSHIP & ADMINISTRATION 389851 5 MEMBER PREMIUM PAYMENTS 900099 44479035 44479035 44479035 731556 731556 8827811 8871968 -44157 -44157 -44157 45166434 44479035 0 687399 113600 42223384 8000 4214390 62674 51045 30531 2315941 3715 8184 600 35179 TAXES & LICENSES 134396 PCORI FEE 21278 49222917 5078520 4200929 968108 951949 27088275 23885831 33134903 29038709 618786 404542 301638 474911 3878276 3455832 4798700 4335285 X 0 0 0 0 28336203 24703424 28336203 24703424 33134903 29038709 X -4056483 405330 18374 X 0 1 X 1 0 0 DUE AND UNPAID CLAIMS 3352000 DUE TO RELATED PARTY 103832 3455832 X 45537518 405330 405330 45132188 34246 34246 45166434 49188671 0 49188671 34246 34246 49222917 PART X, LINE 2: MANAGEMENT ANALYZED TAX POSITIONS TAKEN BY THE TRUST, AND CONCLUDED THAT AS OF DECEMBER 31, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 0 HOSPICE OF THE PIEDMONT INC 1801 WESTCHESTER DR HIGH POINT NC 27262 581453827 501(C)(3) 23400 0 GENERAL SUPPORT CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY 13808 PROFESSIONAL CENTER DR HUNTERSVILLE NC 28078 562059693 N/A 18000 0 GENERAL SUPPORT UROLOGY SPECIALISTS OF THE CAROLINAS PLLC 1518 3RD ST SUITE 250 CHARLOTTE NC 28204 562107759 N/A 17850 0 GENERAL SUPPORT THE MENTAL HEALTH FUND INC 327 1ST AVE NW HICKORY NC 28601 562151678 501(C)(3) 10550 0 GENERAL SUPPORT ORTHOPAEDIC SPECIALISTS OF NORTH CAROLINA PA PO BOX 1107 WAKE FOREST NC 27588 562232487 N/A 10350 0 GENERAL SUPPORT MID-ATLANTIC EMERGENCY MEDICAL ASSOCIATES PLLC 501 S SHARON AMITY RD SUITE 300 CHARLOTTE NC 28211 562066152 N/A 9900 0 GENERAL SUPPORT BURLINGTON PEDIATRICS PA 530 W WEBB AVE BURLINGTON NC 27217 561211337 N/A 6300 0 GENERAL SUPPORT CARY PEDIATRIC CENTER PA 1001 CRESCENT GREEN CARY NC 27518 364351186 N/A 5550 0 GENERAL SUPPORT NEUROLOGY AND PAIN MANAGEMENT CENTER PLLC 350 PINE STATE ST LILLINGTON NC 27546 201843747 N/A 5400 0 GENERAL SUPPORT 2 7 NORTH CAROLINA MEDICAL SOCIETY SPONSORING ORGANIZATION 394408 SERVICES RENDERED 0 FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HIRED MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA TO MANAGE THE DAY-TO-DAY OPERATIONS PURSUANT TO A WRITTEN MANAGEMENT AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE TRUST PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENT IS REVIEWED FOR POTENTIAL AND POSSIBLE CONFLICTS OF INTEREST AND ANY SUCH FINDING IS FORWARDED TO THE CHAIRMAN AND SPONSOR. FORM 990, PART VI, SECTION C, LINE 19 THE TRUST'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE FILED WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE AND ARE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS 18,374. 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