Secretary of Labor v. James Doyle

657 F. App'x 117
Court of Appeals for the Third Circuit·Decided August 18, 2016·No. 15-1380; 15-1574·Unpublished·Cited by 2 cases

Opinion

OPINION *

GREENAWAY, JR., Circuit Judge.

This matter returns to the Third Circuit on a consolidated appeal. The District Court found, based on evidence adduced at a bench trial, that Appellants James Doyle and Cynthia Holloway breached their fiduciary duties to the Professional Industrial Trade Workers Union (“PITWU”) Health & Welfare Fund (“Fund”), a plan governed by the Employee Retirement Income Security Act (“ERISA”). For the reasons that follow, we will affirm the District Court’s judgment as to Doyle, and vacate and remand the District Court’s judgment as to Holloway.

I. BACKGROUND

A. Factual Background

The District Court’s full factual findings are set forth in our prior opinion and. the District Court’s opinion following remand; we need not repeat them in detail here. However, we provide an overview of the facts for context.

Holloway first learned of PITWU from an insurance broker in 2000, after David Weinstein had established PITWU earlier that year. After an attorney provided Holloway with verification of PITWU’s union status, she and three other individuals established the Fund on May 1, 2001, as reflected by an Agreement and Declaration of Trust. The Fund operated until May 2003 as a multiple employer welfare arrangement providing health benefits to numerous small employers. Holloway’s company, Employers Depot, Inc. (“EDI”), was a member of the Fund from the Fund’s inception. EDI was a professional employer organization (“PEO”). Generally, PE Os provide human resources services to client-employers as well as payroll, workers’ compensation, and health and retirement benefits.

. The Fund had various third-party administrators who reviewed and paid health claims covered by the Fund, as well as trustees, counsel, and an actuary. The Fund’s initial claims administrator was Union Privileged Care (“UPC”), which was owned by Weinstein. Holloway served as one of the original Fund trustees from the Fund’s creation until she resigned on September 27,2002.

Weinstein also owned two PEOs, Privileged Care, Inc. (“PCI”) and NorthPoint PEO (“NP”), 1 which became members of the Fund sometime after January 2002 by entering into ostensible collective bargaining agreements (“CBÁs”) with PITWU. 2 *120 In the CBAs, PCI/NP agreed to contribute to the Fund at specified rates so that their client-employers could receive health benefits under the Fund.

Doyle’s company, Privilege Care Marketing Group (“PCMG”), contracted with PCI/NP to market PEO services and access to the Fund to small businesses. Client-employers gained access to the Fund by checking a “health benefit” box and a “union” box on enrollment forms, even though their employees did not become members of PITWU. Although enrollment forms listed a number of additional PEO services, the only service consistently offered by PCI/NP was health benefits through the Fund.

When businesses decided to enroll their employees in the Fund (and become client-employers of PCI/NP), Doyle required them to initially pay a single check to PCMG. Thereafter, Doyle required PCI/ NP’s client-employers to make monthly payments to PCMG via two checks. PCMG remitted the first check (“Check 1”) to PCI/NP and retained the second check (“Check 2”) as various fees and marketing commissions. PCI/NP retained a portion'of Check 1, sent a portion back to PCMG as a “refund,” paid a portion- to PITWU as “union dues,” and sent the remainder to claims administrators.

In January 2002, less than a month after PCI/NP and PCMG became members of the Fund, the Oklahoma Insurance Commissioner entered a cease and desist order against PCI, PCMG, and two of its marketing affiliates. The Commissioner found that they were engaging in the unauthorized sale of insurance and therefore ordered them to cease and desist from any further sales or marketing of insurance in the state.

Weinstein’s company, UPC, was replaced as the claims administrator in March 2002. At an April 23, 2002 meeting with the Fund’s new claims administrator, Holloway learned of “several boxes” of pending, unpaid claims from member-employees, and of concern that claims may not have been paid since November 2001. J.A. 161-63, 1005-06. Holloway requested a date by which all claims be entered into the Fund’s database to determine the magnitude of unpaid or pending claims.

Despite Holloway’s “general concerns” about Weinstein, Holloway and another trustee appointed Weinstein as a trustee to the Fund. J.A. 1008, 1013. 3 However, at a subsequent trustee meeting held on May 30, 2002, Weinstein resigned as trustee. At this meeting, the Fund’s accountant informed the trustees that he could not prepare a financial statement for the Fund because the financial information he had requested from UPC had not yet been provided. The Fund’s actuary reported that it had received insufficient information from Weinstein to offer an opinion on whether the Fund was underfunded. The trustees developed a plan -with Weinstein *121 to provide all necessary data.- 4

In June 2002, the Louisiana Insurance Commissioner issued a cease and desist order based on its finding that that PCI/NP was selling health insurance without authorization. The Commissioner found that there was no collective bargaining by PITWU on behalf of its members and that client-employers of PCI/NP received no representation or benefit from PITWU other than access to the Fund. 5

On September 20, 2002, the Fund’s new claims administrator informed Holloway of problems relating to lack of funding because of PCI/NP’s failure to make contributions to the Fund and other problems arising from inadequate paperwork. In a letter dated September 20, 2002, Holloway resigned as trustee. In her letter.of resignation, she identified multiple reasons leading to her resignation, including the lack of financial accountability for contributions to the Fund and the resulting lack of funding to pay claims. Holloway also noted that several states had issued cease and desist orders “based on the representation by other membership/trustees that PITWU [was] an insurance program.” J.A. 196-97.

PCMG received a total of $2.1 million ($2,107,361) in Check 2 monies, which it retained as marketing commissions and fees. J.A. 417 (Column 16, Row 33).

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Secretary of Labor v. James Doyle, 657 F. App'x 117 (3d Cir. 2016).

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