2021-11-14T12:58:13-06:00 2020-12-31 450250958 EIDE BAILLY LLP 10681 FOOTHILL BLVD STE 300 RANCHO CUCAMONGA CA 917303831 990 2020-01-01 686068469 INSURANCE AND BENEFITS TRUST OF THE PEACE OFFICERS RESEARCH ASSOC OF CA INSU 9169283777 4010 TRUXEL ROAD SACRAMENTO CA 95834 FRANCO VADO TRUSTEE 9169283777 2021-11-14 1 FRANCO VADO 999009999 CATHERINE L GRAY P01294460 9094664410 2021-11-14 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z FRANCO VADO 4010 TRUXEL ROAD SACRAMENTO CA 95834 196201845 0 X N/A X 1991 CA TO PROVIDE DISABILITY, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, CANCER, ACCIDENT AND HOSPITAL BENEFITS TO MEMBERS. 11 11 12 11 2959415 0 0 0 175111776 174070403 2180336 2959415 28611314 18926139 205903426 195955957 0 0 192554828 158302520 0 0 0 0 0 11523802 11389220 204078630 169691740 1824796 26264217 98196410 132160569 30034115 19229357 68162295 112931212 NONE 0 0 TO PROVIDE DISABILITY, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, CANCER, ACCIDENT AND HOSPITAL BENEFITS TO APPROXIMATELY 60,000 MEMBERS, THE CONTRIBUTIONS FOR WHICH ARE MADE BY MEMBERS, MEMBER ASSOCIATIONS AND IN SOME CASES BY MEMBERS' EMPLOYERS, IN ACCORDANCE WITH COLLECTIVE BARGAINING AGREEMENTS. IN ADDITION, A MAJOR MEDICAL ADMINISTRATIVE SERVICES BENEFIT WAS ESTABLISHED ON JANUARY 1, 2018 AND BEGAN RECEIVING CONTRIBUTIONS AND PROVIDING BENEFITS FROM THIS TRUST. PREVIOUS TO THIS DATE, PARTICIPANTS WERE PART OF FULLY INSURED BENEFIT PLAN. ONLY AS OF JANUARY 1, 2018, DID THIS TRUST INCLUDE A SELF-INSURED MAJOR MEDICAL PLAN FOR SUCH PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 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 22 0 1 12 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X PORAC 9169283777 4010 TRUXEL ROAD SACRAMENTO CA 95834 X MARIA JIMENEZ CHIEF OPERATIONS OFFICER 40.00 X 201741 0 12269 FRANCO VADO CHAIRMAN 5.00 X X 0 0 0 RICHARD BUSS VICE-CHAIRMAN 5.00 X X 0 0 0 ISRAEL REYES TREASURER 5.00 X X 0 0 0 RUSTY REA SECRETARY 5.00 X X 0 0 0 DAMON KURTZ TRUSTEE 5.00 X 0 0 0 BRYAN HUBBARD TRUSTEE 5.00 X 0 0 0 PATRICK MARTIN TRUSTEE 5.00 X 0 0 0 CODY GREEN TRUSTEE 5.00 X 0 0 0 GARY FRACE TRUSTEE 5.00 X 0 0 0 ROGER GARCIA TRUSTEE 5.00 X 0 0 0 SHANE TALBOT TRUSTEE 5.00 X 0 0 0 201741 0 12269 1 0 1 0 ANTHEM BLUE CROSS 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 5939639 MEDICARE 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 1348237 INSURANCE BENEFIT TRUST OF PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 793689 MYER-STEVENS TOOHEY 26101 MARGUERITE PARKWAY MISSION VIEJO CA 92692 PROVIDER 580607 4 PARTICIPANT CONTRIBUTIONS 900099 165151298 165151298 PREMIUM CONTRIBUTIONS REVENUE 900099 8919105 8919105 174070403 2144302 2144302 1061001 245888 815113 815113 815113 OTHER 900099 16781720 16781720 LTD CLAIMS RECOVERIES 900099 1116707 1116707 ADMIN FEE REVENUE 900099 1027312 1027312 400 400 18926139 195955957 192996542 2959415 0 158302520 2383672 113922 58800 408609 8115952 57842 15548 32752 8396 102242 SUPPLIES AND TELEPHONE 41125 PCORI FEE 26279 MISCELLANEOUS 8920 ACA INSURER 8004 7157 169691740 11913175 17781470 5649972 433028 13781534 13360355 89953 69894 5783617 5600 115547 5778017 65098664 86639900 1547565 8097905 98196410 132160569 12898767 4311013 17135348 14918344 30034115 19229357 X 0 0 0 0 68162295 112931212 68162295 112931212 98196410 132160569 26264217 4702224 13802476 0 X X 0 1 X 1 0 5624285 5624285 159332 5600 153732 5778017 ESTIMATED RECOVERABLE CLAIMS RECEIVABLE 1270476 ADMINISTRATIVE FEE RECEIVABLE 343996 DUE FROM OTHER TRUSTS 281429 ACCRUED INTEREST AND DIVIDENDS 172836 STOP LOSS RECEIVABLE 529168 PRESCRIPTIONS REBATES RECEIVABLE 5500000 8097905 ACCRUED VACATION/PAYROLL TAXES 73147 GROUP INSURANCE PREMIUMS PAYABLE 405611 SELF-FUNDED BENEFITS CLAIMS PAYABLE 1536386 INCURRED BUT NOT REPORTED CLAIMS 12779000 DUE TO OTHER TRUST 124200 14918344 X 200249572 4702224 4702224 195547348 408609 408609 195955957 171638764 0 171638764 408609 -2355633 -1947024 169691740 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST ADMINISTRATOR BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN NET BENEFIT OBLIGATIONS -2,355,633. 0 0 0 MARIA JIMENEZ CHIEF OPERATIONS OFFICER 201741 0 0 0 0 0 500 0 11769 0 214010 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT YEARLY MAKES 3 APPOINTMENTS TO THE TRUST: 1) PRESIDENTS APPOINTMENT, 2) BOARD REPRESENTATIVE AND 3) RETIREE REPRESENTATIVE FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES ARE PROVIDED THE TAX RETURNS AND ASKED TO REMARK IF THEY HAVE ANY CHANGES. FORM 990, PART VI, SECTION B, LINE 12C NEW TRUSTEES ARE REQUIRED TO ATTEND ANNUAL TRAINING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART VII SECTION A COLUMN E AND F ALL THE TRUSTEES ARE VOLUNTEERS AND ARE NOT COMPENSATED BY ANY RELATED ENTITIES FOR THEIR WORK ON THE TRUST. RETIRED TRUSTEES AND MOST ACTIVE TRUSTEES ARE NOT COMPENSATED BY A CONTRIBUTING EMPLOYER OR SPONSOR ORGANIZATION. AN ACTIVE TRUSTEE OF THE TRUST IS AN EMPLOYEE OF A RELATED SPONSOR ORGANIZATION UNDER THE DEFINITIONS IN SCHEDULE R. THE TRUST REQUESTED THE COMPENSATION INFORMATION REGARDING THE RELATED ORGANIZATION FROM THE VOLUNTEER TRUSTEE. THE TRUST PROVIDED A QUESTIONNAIRE REQUESTING THE REQUIRED INFORMATION ALONG WITH INSTRUCTIONS TO EXPLAIN THE INFORMATION NEEDED. THE TRUST IS UNABLE TO REPORT COMPENSATION AND BENEFITS PAID TO VOLUNTEER TRUSTEES BY RELATED ORGANIZATIONS AS IT WAS UNABLE TO OBTAIN THE INFORMATION AFTER MAKING REASONABLE EFFORTS. FORM 990,PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. ALAMEDA CO DSA ALAMEDA POA ALBANY POA ALHAMBRA POA AMADOR CO SOA ANAHEIM POA ANTIOCH POA ANTIOCH PSMA ARCADIA POA ARCATA POA ARROYO GRANDE POA ATWATER POA AUBURN POA AZUSA POA AZUSA PMA BART POA BART PMA BELMONT POA BERKELEY POA BRENTWOOD POA BUENA PARK POA BURBANK AIRPORT POA (NS) BUTTE CO CORRECTIONS BUTTE CO DSA CALAVERAS CO DSA CALAVERAS CO SHERIFF'S MGMNT CENTRAL MARIN POLICE AUTH CERES POA CHICO POA CHOWCHILLA POA CHULA VISTA POA CITY OF HERCULES POA CITY OF SANTA ROSA POA CITY OF SANTA ROSA PMA CLOVIS POA COLTON POA CONTRA COSTA CO DSA COTATI POA DESERT HOT SPRINGS POA EAST BAY REG PARK EL MONTE POA EL SEGUNDO POA ESCONDIDO POA EUREKA POA EXETER POA FONTANA PMA FONTANA SCHOOLS POA FT BRAGG POA FOUNTAIN VALLEY POA FRESNO CO DSA FRESNO CO DAIA FRESNO POA GARDENA POA GILROY POA GRASS VALLEY POA GUSTINE POA HANFORD POA HOLLISTER POA HUMBOLDT CO DSO IMPERIAL CO DAIA IMPERIAL CO DSA IMPERIAL CO PSMA INYO CO DSA KINGS CO DSA LA HABRA POA LA MESA POA LA PALMA POA LAKE CO CORRECTIONS LAKE CO DSA LAKEPORT POA LEMOORE POA LIVERMORE POA LODI POA LA AIRPORT LOCAL 777 LA AIRPORT SUPERVISORS LINCOLN POA MAMA OF LODI MADERA CO DSA MANHATTAN BCH POA MANTECA POA MARIN CO DSA MARTINEZ POA MODESTO POA MODOC CO DSA MONTEREY CO DSA MONTEREY CO SHERIFF'S MGMNT ASSOC MONTEREY CO PROBATION MONTEREY PK POA MONTEREY PK MID MGMNT MOUNTAIN VIEW POA NAPA CO DSA NAPA POA NAPA MID-MANAGEMENT POA NEWMAN POA NOVATO PMA NOVATO POA OAKDALE POA OAKLAND POA ORANGE POA OROVILLE POA OXNARD POA PALM SPRINGS POA PALO ALTO PMA PALO ALTO POA PIEDMONT POA PINOLE PEA PITTSBURG POA PLACER CO DSA PLEASANT HILL POA PLEASANTON POA POMONA POA PORT SAN LUIS PORTERVILLE POA REDDING PMA ROCKLIN POA ROHNERT PARK POA ROSEVILLE POA SACRAMENTO (SCALE) SACRAMENTO POA SALINAS POA SAN BENITO DSA SAN BERNARDINO POA SAN BERNARDINO SCHOOLS POA SAN DIEGO SCHOOLS POA SAN DIEGO SCHOOLS PMA SAN DIEGO HARBOR SAN FRANCISCO DSA SAN JOAQUIN CORRECTIONS SAN JOAQUIN DAIA SAN JOAQUIN DSA SAN JOSE POA SAN LEANDRO PMA SAN LUIS OBISPO DSA SAN LUIS OBISPO (ASLOCDS) SAN MATEO POA SAN MATEO PROBATION ASSOC SAN MATEO SAFETY MGMNT SAN MATEO POLICE SGTS ASSOC SAN RAFAEL POA SANGER POA SANTA ANA SCHOOL POA SANTA BARBARA DSA SANTA BARBARA POA SANTA CLARA CORRECTIONS SANTA CLARA CO DAIA SANTA CRUZ CO CORRECTIONS SANTA CRUZ DSA SANTA CRUZ LT'S SANTA CRUZ REP UNIT SANTA MARIA POA SANTA MARIA PA OF MID MGMNT SANTA MONICA POA SEBA SEBASTOPOL POA SHASTA CO DSA SHASTA CO DMA SOLANO CO DSA SONOMA CO LEA SONOMA CO LEA MGRS SONOMA CO DSA & MGMNT SONORA POA STANISLAUS CO DSA STANISLAUS SPRVSRS STANISLAUS DA INV STANISLAUS SWORN DEPUTIES STOCKTON UNIFIED POA SUISUN CITY TRACY POA TRUCKEE POA TULARE CO DSA TUOLUMNE CO DSA VACAVILLE PMA VACAVILLE POA VALLEJO POA VENTURA CO DSA VENTURA POA WEST SACRAMENTO POA WHITTIER POA WHITTIER PMA WOODLAND PROF PEA YOLO CO DSA YREKA POA YUBA CITY POA YUBA CO SMSA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.