2024-04-12T10:56:49-05:00 2023-05-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2022-06-01 562138565 NORTH CAROLINA BANKERS ASSOCIATION HEALTH BENEFIT TRUST NORT 9197817979 PO BOX 19999 RALEIGH NC 276191999 MARK HOLMES SVP & CFO 9197817979 2024-02-27 1 MARK HOLMES 999009999 0 J CALVIN MARKS P01226973 9197196400 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARK HOLMES PO BOX 19999 RALEIGH NC 276191999 30680454 0 X N/A X 1999 NC SELF-FUNDED MULTIPLE EMPLOYER WELFARE ASSOCIATION BENEFIT PLAN 5 5 0 5 0 0 0 0 28908805 30603342 52533 65362 0 11750 28961338 30680454 0 0 26919024 26100883 0 0 0 0 0 4824818 5662255 31743842 31763138 -2782504 -1082684 13216517 11956356 2315822 2047420 10900695 9908936 SELF-FUNDED MULTIPLE EMPLOYER WELFARE ASSOCIATION BENEFIT PLAN 0 0 THE NCBA HEALTH BENEFIT TRUST PROVIDED COVERAGE FOR AN AVERAGE OF 2,350 EMPLOYEES AND DEPENDENTS OF NCBA MEMBER INSTITUTIONS IN THE PAST PLAN YEAR. THE PLAN COLLECTED PREMIUMS AND PAID CLAIMS IN ACCORDANCE WITH THE TRUST AGREEMENT. 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 0 1 1 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X DIANE BALDWIN 9197817979 3601 HAWORTH DRIVE RALEIGH NC 27609 DAVID SAULS CHAIRMAN 1.00 X 0 0 0 MIKE AYOTTE TRUSTEE 1.00 X 0 0 0 DAVID KEUL TRUSTEE 1.00 X 0 0 0 DEBRA MEDLIN TRUSTEE (FROM SEP '22) 1.00 X 0 0 0 LARISSA PROCIUK TRUSTEE (FROM JUN '22) 1.00 X 0 0 0 STEPHANIE TUCKER CFO 1.00 39.00 X 0 186353 20067 0 186353 20067 0 0 1 0 BLUE CROSS AND BLUE SHIELD OF NC 5901 CHAPEL HILL ROAD DURHAM NC 27707 ADMINISTRATIVE SERVICES 1331060 COMMUNITY BANK SERVICES PO BOX 19999 RALEIGH NC 276191999 THIRD PARTY ADMINISTRATOR 1138320 BUSINESSSOLVERCOM INC PO BOX 850411 MINNEAPOLIS MN 554850411 ADMINISTRATIVE SERVICES 102236 3 PARTICIPANT CONTRIBUTIONS 525100 28639193 28639193 REBATE & OTHER INCOME 525100 1807396 1807396 COBRA PREMIUMS 525100 156753 156753 30603342 65362 65362 11750 11750 11750 30680454 30603342 0 77112 26100883 22260 81572 2773727 12502 REINSURANCE PREMIUMS 2518417 ENROLLMENT EXPENSES 120152 PROVIDER FEES 89221 INCOME TAX 40688 3716 31763138 11866757 10167858 7294 1342466 1788498 13216517 11956356 489822 5420 1826000 2042000 2315822 2047420 X 0 0 0 0 10900695 9908936 10900695 9908936 13216517 11956356 X -1082684 314219 -223294 X 0 1 X 1 0 0 STOP LOSS RECEIVABLE 953544 SECURITY DEPOSIT 475000 CAPTIVE COLLATERAL 287474 ACCRUED INTEREST 38548 INCOME TAX REFUND 33932 1788498 BENEFIT CLAIMS PAYABLE 2042000 2042000 X 26342891 0 26342891 4337563 4337563 30680454 27641575 216000 216000 27425575 4337563 4337563 31763138 PART X, LINE 2: MANAGEMENT ANALYZED TAX POSITIONS TAKEN BY THE TRUST, AND CONCLUDED THAT AS OF MAY 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECORDED AS CONTRA-REVENUE ON THE FINANCIAL STATEMENTS 2,518,417. REVENUE RECORDED AS CONTRA-EXPENSE ON THE FINANCIAL STATEMENTS 1,819,146. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS 216,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECORDED AS CONTRA-REVENUE ON THE FINANCIAL STATEMENTS 2,518,417. REVENUE RECORDED AS CONTRA-EXPENSE ON THE FINANCIAL STATEMENTS 1,819,146. 0 0 0 STEPHANIE TUCKER CFO 0 165000 0 14400 0 6953 0 18728 0 1339 0 206420 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION WILL SUBMIT ITS FORM 990 TO THE FULL BOARD OF TRUSTEES FOR THEIR REVIEW PRIOR TO FILING. UPON THE REVIEW AND APPROVAL BY THE TRUSTEES, THE ORGANIZATION WILL FILE ITS FORM 990. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE REQUIRED TO SIGN AND RETURN ACKNOWLEDGMENT FORMS ATTESTING THAT THEY WILL COMPLY WITH THE ORGANIZATION'S ETHICS POLICY AND PROVIDE NOTICE OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT THAT PERSON RECUSES THEMSELVES FROM ALL DISCUSSIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DID NOT COMPENSATE ANY OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET CHANGE IN BENEFIT OBLIGATIONS -216,000. NONADMITTED PREPAID INSURANCE PREMIUM -7,294. NORTH CAROLINA BANKERS ASSOCIATION 3601 HAWORTH DRIVE RALEIGH NC 27609 560340440 TO OFFER EDUCATION AND SERVICES TO THE FINANCIAL INSTITUTIONS OF NC NC 501(C)(6) 0 ALLIANCE BANK & TRUST AMERICAN BANK & TRUST BELMONT FEDERAL SAVINGS BLACK MOUNTAIN SAVINGS BANK BLUEHARBOR BANK COASTAL BANK & TRUST DOGWOOD STATE BANK F&M BANK FIRST CAPITAL BANK FIRST CAROLINA BANK FIRST FEDERAL BANK FIRST FEDERAL SAVINGS FIRST SAVINGS & LOAN HERTFORD SAVINGS BANK SSB JACKSON SAVINGS BANK SSB KS BANK INC LUMBEE GUARANTY BANK M&F BANK MORGANTON FEDERAL SAVINGS NANTAHALA BANK & TRUST CO NEW REPUBLIC SAVINGS BANK NORTH STATE BANK OLD NORTH STATE TRUST LLC PARAGON BANK PROVIDENCE BANK RIVERSIDE SAVINGS BANK ROXBORO SAVINGS BANK SOUTHERN BANK TARBORO SAVINGS BANK SSB TAYLORSVILLE SAVINGS BANK TRIAD BUSINESS BANK WAKE FOREST FEDERAL SAVINGS WEST TOWN BANK & TRUST 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0