2024-11-06T07:27:29-06:00 2023-12-31 621199757 LBMC PC PO BOX 1869 BRENTWOOD TN 370241869 990 2023-01-01 581403006 LIFE CARE CENTERS OF AMERICA INC WELFARE BENEFITS PLAN LIFE 4234729585 PO BOX 3480 3001 KEITH STREET NW CLEVELAND TN 37320 J STEPHEN ZIEGLER TRUSTEE 4234729585 2024-11-04 1 0 ABIGAIL CAMPBELL P01296738 6153774600 2024-10-29 2023 2024-10-15 13:58:12Z J STEPHEN ZIEGLER 3570 KEITH STREET NW CLEVELAND TN 37312 153144731 0 X N/A X 2005 TN VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2 0 0 0 383739 382739 0 0 137310738 152760992 62479 383739 0 0 137373217 153144731 0 0 118129996 117270145 575366 593117 0 0 0 21584428 35116648 140289790 152979910 -2916573 164821 23670805 23813624 12135485 10873483 11535320 12940141 THE PLAN WAS ESTABLISHED TO PROVIDE HEALTH , PRESCRIPTION DRUG, LIFE, DENTAL, VISION, TEMPORARY DISABILITY, AND LONG-TERM DISABILITY INSURANCE TO SUBSTANTIALLY ALL REGULAR FULL-TIME EMPLOYEES OF LIFE CARE CENTERS OF AMERICA, INC. 0 0 LIFE CARE CENTERS OF AMERICA HAS FORMED A VEBA UNDER IRC SECTION 501(C)(9) TO PROVIDE MEDICAL, DENTAL, VISION, DISABILITY AND LIFE BENEFITS. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 2 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X LIFE CARE CENTERS OF AMERICA INC 4234729585 3570 KEITH STREET CLEVELAND TN 37312 X FORREST L PRESTON TRUSTEE 4.00 X 0 0 0 J STEPHEN ZIEGLER TRUSTEE 4.00 X 0 0 0 0 0 0 0 0 0 0 0 EMPLOYEE/R CONTRIBUTION 525100 93184205 93184205 PARTICIPANT CONTRIBUTION 525100 59576787 59576787 152760992 383739 383739 153144731 152760992 383739 0 117270145 496179 61464 35474 14269 38845 1272853 63318 16759830 HMO CONTRIBUTIONS 13158683 SERVICE FEES 3689633 ADMINISTRATIVE & MANAGE 60254 INCOME TAX PAID 58963 152979910 1028762 968563 16846287 11432284 4241519 11273174 1554237 139603 23670805 23813624 154199 151121 11981286 10722362 12135485 10873483 X 11535320 12940141 11535320 12940141 23670805 23813624 X 164821 1240000 X 0 1 X 0 0 0 PLAN BENEFIT OBLIGATIONS 10722362 10722362 X 153144731 0 153144731 0 153144731 152979910 0 152979910 0 152979910 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS QUALIFIES AS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(9) OF THE IRC. THE INTERNAL REVENUE SERVICE MADE A FAVORABLE DETERMINATION IN A LETTER DATED SEPTEMBER 29, 2006, THAT THE PLAN MEETS THE REQUIREMENTS OF IRC SECTION 501(C)(9) AND IS, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES UNDER IRC SECTION 501(A). THE PLAN HAS SINCE BEEN AMENDED. THE BOARD OF TRUSTEES, PLAN SPONSOR AND PLAN ADMINISTRATOR BELIEVE THAT THE PLAN CONTINUES TO QUALIFY AND OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC; THEREFORE, NO PROVISION FOR INCOME TAXES IS REFLECTED IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO INCOME TAX ON UNRELATED BUSINESS INCOME. UNRELATED BUSINESS INCOME IS THE INCOME FROM A TRADE OR BUSINESS REGULARLY CARRIED OUT BY AN EXEMPT ORGANIZATION AND NOT SUBSTANTIALLY RELATED TO THE PERFORMANCE BY THE ORGANIZATIONOF ITS EXEMPT PURPOSE OR FUNCTION. THE PLAN HAD UNRELATED BUSINESS INCOME FROM INTEREST INCOME RECEIVED ON THE INVESTMENTS OF THE TRUST IN 2019. NO SIGNIFICANT TAX AMOUNTS WERE ASSOCIATED WITH THE INCOME. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 2 LIFE CARE CENTERS OF AMERICA, INC. (LCCA) IS THE PLAN SPONSOR OF THE LCCA WELFARE BENEFITS PLAN. THE LCCA WELFARE BENEFITS PLAN (FORMERLY KNOWN AS THE LCCA ASSOCIATE BENEFIT PLAN) CONSTITUTES UNDER SECTION 501 (C)(9) OF THE CODE A VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION. FORREST PRESTON, TRUSTEE, IS THE CHAIRMAN OF LCCA. J. STEPHEN ZIEGLER, TRUSTEE, IS THE CHIEF FINANCIAL OFFICER OF LCCA. ANY QUESTIONS AS TO THEIR COMPENSATION PAID BY LCCA WILL BE ADDRESSED UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS, WHO PERFORM THE FINANCIAL STATEMENT AUDIT. A COPY OF FORM 990 IS PROVIDED TO THE TRUSTEES, ALLOWING SUFFICIENT TIME FOR THEIR REVIEW BEFORE THE DUE DATE. ANY SIGNIFICANT ITEMS OF INTEREST OR QUESTIONS RAISED BY THE TRUSTEES RESULTING FROM THEIR REVIEW OF FORM 990 ARE RESOLVED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL ASSOCIATES, INCLUDING OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO TRAIN AND SUCCESSFULLY PASS THE CODE OF CONDUCT TRAINING AND TESTING. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, AS PART OF THE FORM 5500, ARE POSTED BY DOL., ALL OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFIT OBLIGATION 1,240,000. LIFE CARE CENTERS OF AMERICA INC 3570 KEITH STREET CLEVELAND TN 37312 620963862 RESIDENTIAL CARE FACILITIES OPERATION AND MANAGEMENT TN N/A S 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 LIFE CARE CENTERS OF AMERICA INC O 593117 CASH LIFE CARE CENTERS OF AMERICA INC P 1449539 CASH