2024-10-15T10:07:56-05:00 2023-12-31 882730877 CHERRY BEKAERT ADVISORY LLC 3800 GLENWOOD AVE SUITE 200 RALEIGH NC 27612 990 2023-01-01 856586606 INDEPENDENT CARE HEALTH BENEFIT TRUST INDE 8554463227 110 DONMOOR COURT GARNER NC 27529 COLIN FELMET CHAIR OF THE BOARD OF TRUSTEES 8554463227 2024-10-15 1 1 MELANIE MCPEAK P01346034 9197821040 2023 2024-10-15 13:58:12Z COLIN FELMET 110 DONMOOR COURT GARNER NC 27529 8536680 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 32504 30754 0 0 8591721 8504176 0 32504 0 0 8591721 8536680 0 0 7142645 8256089 0 0 0 0 0 1153551 1458259 8296196 9714348 295525 -1177668 4657865 4550644 4362340 5440046 295525 -889402 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 1 0 1 0 1 1 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 0.00 X 0 0 0 CONRAD FLICK TRUSTEE 0.50 19.50 X 0 108000 0 JOSEPH MOOSE TRUSTEE 0.50 0.00 X 0 0 0 CHRISTOPHER WOODFIN TRUSTEE 0.50 39.50 X 0 595189 674656 RONALD SMITH EXECUTIVE BUSINESS ADVISOR 30.00 10.00 X 0 535240 16882 0 1238429 691538 0 0 1 0 BLUE CROSS BLUE SHIELD OF NORTH CAROLINA PO BOX 580017 CHARLOTTE NC 282580017 THIRD PARTY ADMINISTRATOR 331311 VIMLY BENEFIT SOLUTIONS 12121 HARBOUR REACH DR STE 105 MUKILTEO WA 98275 BENEFITS CONSULTING 228000 2 MEDICAL PREMIUMS 900099 8504176 8504176 8504176 32504 32504 8536680 8504176 32504 0 8256089 704135 103750 651986 EXCISE TAXES 2769 BANK FEES 411 CECL LOSS ADJUSTMENT -4792 9714348 3730181 237408 3932504 927684 154232 0 226500 4657865 4550644 282965 256921 4079375 5183125 4362340 5440046 X 0 0 0 0 295525 -889402 295525 -889402 4657865 4550644 X -1177668 -7259 X 0 1 X 1 0 0 RELATED PARTY PROMISSORY NOTES & INTEREST PAYABLE 5183125 5183125 X 9058581 436431 85470 521901 8536680 0 8536680 10030649 436431 -205600 230831 9799818 -85470 -85470 9714348 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 HAD IMMATERIAL UNRELATED BUSINESS INCOME FOR THE YEAR ENDED DECEMBER 31, 2023. THE TRUST HAD NO UNRELATED BUSINESS INCOME FOR THE YEAR ENDED DECEMBER 31, 2022. 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 85,470. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS -205,600. PART XII, LINE 4B - OTHER ADJUSTMENTS: STOP-LOSS INSURANCE REBATES -85,470. 0 0 0 CHRISTOPHER WOODFIN TRUSTEE 0 411567 0 181137 0 2485 0 646500 0 28156 0 1269845 0 0 RONALD SMITH EXECUTIVE BUSINESS ADVISOR 0 409904 0 123857 0 1479 0 13282 0 3600 0 552122 0 0 PART I, LINE 3 INDEPENDENT CARE HEALTH BENEFIT TRUST DOES NOT HAVE ANY EMPLOYEES. ALL INDIVIDUALS PERFORMING WORK FOR THE ORGANIZATION ARE EMPLOYED BY COMMUNITY CARE OF NORTH CAROLINA, INC., (CCNC) A RELATED ORGANIZATION. CCNC USED THE FOLLOWING PROCEDURES TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN COMPENSATION CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. 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. FORM 990, PART XI, LINE 9: CECL ADJUSTMENT TO BEGINNING EQUITY AT 1/1/2023 -7,259. 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