SPECIAL AGENTS MUTUAL BENEFIT: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
SPECIAL AGENTS MUTUAL BENEFIT (EIN 52-1074154)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-15
IRS object ID
202143199349329569
Schema version
2020v4.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-15T19:37:56-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WITHUMSMITHBROWNPCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14600 EAST WEST HWY 900AddressLine1Txt
CityBETHESDACityNm
State AbbreviationMDStateAbbreviationCd
ZIP208143423ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521074154EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% PAMELA LYNCHInCareOfNm
Business Name ControlSPECBusinessNameControlTxt
Phone3019841440PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line111301 OLD GEORGETOWN ROADAddressLine1Txt
CityROCKVILLECityNm
State AbbreviationMDStateAbbreviationCd
ZIP20852ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKATHRYN DIEMPersonNm
Person TitleTREASURER & DIRECTORPersonTitleTxt
Phone3019844110PhoneNum
Signature2021-11-13SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKATHRYNPersonFirstNm
Person LastDIEMPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRichard RuvelsonPreparerPersonNm
PTINP00234075PTIN
Phone3012726000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKATHRYN DIEMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line111301 OLD GEORGETOWN ROADAddressLine1Txt
CityROCKVILLECityNm
State AbbreviationMDStateAbbreviationCd
ZIP20852ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$443,816,867GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressWWW.SAMBAPLANS.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1976FormationYr
Legal Domicile StateDCLegalDomicileStateCd
Activity Or MissionTO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN FOR ITS MEMBERSHIP.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee58TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$257,232,061PYProgramServiceRevenueAmt
CY Program Service Revenue$242,813,980CYProgramServiceRevenueAmt
PY Investment Income$5,390,712PYInvestmentIncomeAmt
CY Investment Income$11,823,387CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$3,058CYOtherRevenueAmt
PY Total Revenue$262,622,773PYTotalRevenueAmt
CY Total Revenue$254,640,425CYTotalRevenueAmt
PY Grants And Similar Paid$6,020PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,520CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$212,345,514PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$201,961,541CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,450,733PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,273,908CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$12,170,176PYOtherExpensesAmt
CY Other Expenses$12,027,902CYOtherExpensesAmt
PY Total Expenses$232,972,443PYTotalExpensesAmt
CY Total Expenses$222,265,871CYTotalExpensesAmt
PY Revenues Less Expenses$29,650,330PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$32,374,554CYRevenuesLessExpensesAmt
Total Assets BOY$232,705,645TotalAssetsBOYAmt
Total Assets EOY$239,845,959TotalAssetsEOYAmt
Total Liabilities BOY$96,624,338TotalLiabilitiesBOYAmt
Total Liabilities EOY$87,811,341TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$136,081,307NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$152,034,618NetAssetsOrFundBalancesEOYAmt
MissionTO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN ("THE PLAN") FOR ITS MEMBERSHIP IN ACCORDANCE WITH ERISA AND FEHBA. THE SAMBA BENEFIT PLAN INCLUDES HEALTH, LIFE, DISABILITY, ACCIDENT, DENTAL, VISION AND RELATED COVERAGES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescSPONSORED HEALTH, GROUP TERM LIFE, DISABILITY, ACCIDENT, DENTAL AND VISION BENEFITS FOR APPROXIMATELY 105,152 MEMBERS.Desc
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document16IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee58EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonPAMELA LYNCHPersonNm
Phone3019844109PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line111301 OLD GEORGETOWN ROADAddressLine1Txt
CityROCKVILLECityNm
State AbbreviationMDStateAbbreviationCd
ZIP20852ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
WALTER E WILSON
EXECUTIVE DIRECTOR40.00.0Yes (X)$561,255$0$48,593
JOHN R MARTUCCI
CONTROLLER40.00.0$242,223$0$215,280Yes (X)
PAMELA CUMMINGS
DEPUTY EXECUTIVE DIRECTOR40.00.0$316,836$0$115,882Yes (X)
LYNN CHANG
MANAGER, IT40.00.0$185,194$0$199,280Yes (X)
MARY LIVINGSTON
MANAGER, HEALTH CLAIMS40.00.0$164,258$0$117,157Yes (X)
LAURENCE GROSS
SENIOR PROGRAM ADMINISTRATOR40.00.0$221,863$0$57,540Yes (X)
PAMELA LYNCH
MANAGER, ACCOUNTING/HR40.00.0$205,647$0$71,243Yes (X)
WILLIAM MARTIN
MANAGER, IT40.00.0$188,135$0$59,123Yes (X)
WILLIAM P O'HANLON
PRESIDENT/BOARD MEMBER4.00.0Yes (X)$46,000$0$0Yes (X)
DAVID R LOESCH
VICE PRESIDENT/BOARD MEMBER1.00.0Yes (X)$6,000$0$0Yes (X)
KATHRYN DIEM
TREASURER/BOARD MEMBER1.00.0Yes (X)$6,000$0$0Yes (X)
JOSEPH R DAVIS
BOARD MEMBER1.00.0$6,000$0$0Yes (X)
CHARLENE B THORNTON
BOARD MEMBER1.00.0$6,000$0$0Yes (X)
ANGELA ZENTZ
BOARD MEMBER1.00.0$0$0$0Yes (X)
DAVID ERMER
SECRETARY1.00.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,155,411TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$884,098TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K15IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CIGNA HEALTHCARE
1111 MARKET STREETCHATTANOOGATN37402HEALTH NETWORK ADMIN$4,245,065
EXPRESS SCRIPTS HLD CO
100 PARSONS POND DRFRANKLIN LAKESNJ07417PHARMACY BENEFIT MGR$1,762,848
RAM TECHNOLOGIES INC
275 COMMERCE DRIVE SUITE 100FORT WASHINGTONPA19034SOFTWARE MAINTENANCE$748,105
CHANGE HEALTHCARE
3055 LEBANON PIKE SUITE 1000NASHIVILLETN37214PRINTING & MAILING$564,975
OPTUMINSIGHT INC
PO BOX 84019CHICAGOIL606894002MED RECORD RETRIEVAL$448,258
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K16CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PREMIUMS525100$237,656,075$237,656,075
ADMINISTRATION FEES525100$3,854,411$3,854,411
EXPERIENCE RATING ADJUSTMENT525100$1,297,963$1,297,963
CARRIER INVESTMENT INCOME525100$5,531$5,531
FieldValueIRS element (for citing)
Total Program Service Revenue$242,813,980TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,031,115TotalRevenueColumnAmt
Exclusion$3,031,115ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$197,968,714SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$189,172,078SecuritiesAmt
Other$4,364OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$8,796,636SecuritiesAmt
Other-$4,364OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,792,272TotalRevenueColumnAmt
Exclusion$8,792,272ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$3,058TotalRevenueColumnAmt
Exclusion$3,058ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$3,058OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$254,640,425TotalRevenueColumnAmt
Related Or Exempt Func Income$242,813,980RelatedOrExemptFuncIncomeAmt
Exclusion$11,826,445ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,520TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$201,961,541TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,267,555TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,718,794TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,031,281TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$854,370TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$401,908TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$48,131TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$248,112TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$338,626TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,131,328TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,097,318TotalAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,775,413TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$166,780TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$22,011TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$512,128TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$135,953TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmt
PCORI EXCISE TAX$70,523
TAXES - PROPERTY$75,736
MISCELLANEOUS$387,013
CLEARING HOUSE EXPENSE$18,830

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$222,265,871TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$500BOYAmt
EOY$525EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$81,067,506BOYAmt
EOY$82,073,543EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$20,615,294BOYAmt
EOY$18,863,135EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$494,482BOYAmt
EOY$518,887EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$13,607,408LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$11,590,406LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,116,753BOYAmt
EOY$2,017,002EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$126,809,628BOYAmt
EOY$134,794,778EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,601,482BOYAmt
EOY$1,578,089EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$232,705,645BOYAmt
EOY$239,845,959EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,236,191BOYAmt
EOY$841,893EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$95,388,147BOYAmt
EOY$86,969,448EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$96,624,338BOYAmt
EOY$87,811,341EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$136,081,307BOYAmt
EOY$152,034,618EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$136,081,307BOYAmt
EOY$152,034,618EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$232,705,645BOYAmt
EOY$239,845,959EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$32,374,554ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$2,352,047NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$14,069,196OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$600,000OtherCostOrOtherBasisAmt
Book Value$600,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,742,891OtherCostOrOtherBasisAmt
Depreciation$4,724,709DepreciationAmt
Book Value$1,018,182BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,721,572OtherCostOrOtherBasisAmt
Depreciation$6,372,705DepreciationAmt
Book Value$348,867BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$542,945OtherCostOrOtherBasisAmt
Depreciation$492,992DepreciationAmt
Book Value$49,953BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,017,002TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
SPECIAL RESERVE - OPM$58,200,215
RESERVE FOR UNPAID CLAIMS$23,528,145
ACCRUED PENSION LIABILITY$1,343,434
GROUP INSURANCE PREMIUM PAYABLE$3,045,842
PROVISION FOR POST RETIREMENT$851,812
FieldValueIRS element (for citing)
Total Liability$86,969,448TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$254,094,386TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$2,352,047NetUnrealizedGainsInvstAmt
Other Revenue$1,806,008OtherRevenueAmt
Revenue Not Reported-$546,039RevenueNotReportedAmt
Revenue Subtotal$254,640,425RevenueSubtotalAmt
Total Revenue Per Form990$254,640,425TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$224,071,879TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$1,806,008OtherExpensesIncludedAmt
Expenses Not Reported$1,806,008ExpensesNotReportedAmt
Expenses Subtotal$222,265,871ExpensesSubtotalAmt
Total Expenses Per Form990$222,265,871TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE:U.S. GAAP requires management of a plan to evaluate tax positions taken and record a tax liability if the Plan has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service or other taxing authorities. Management has evaluated tax positions taken by the Plan and concluded that as of December 31, 2020 and 2019 there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the financial statements. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits in progress for any tax periods. In addition, there have been no tax related interest or penalties for periods presented in these financial statements.
PART XI, LINE 2D - OTHER REVENUES ON AUDITED F/S, NOT ON RETURN:INTERPLAN ALLOCATIONS $1,801,644 AND LOSS ON DISPOSAL OF ASSETS OF $4,364
PART XII, LINE 2D - OTHER EXPENSES ON AUDITED F/S, NOT ON RETURN:INTERPLAN ALLOCATIONS $1,801,644 AND LOSS ON DISPOSAL ASSETS OF $4,364

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
WALTER E WILSON
EXECUTIVE DIRECTOR$437,189$117,717$6,349$32,702$0$15,891$0$609,848$0$0$0
PAMELA CUMMINGS
DEPUTY EXECUTIVE DIRECTOR$261,836$55,000$0$99,956$0$15,926$0$432,718$0$0$0
JOHN R MARTUCCI
CONTROLLER$225,223$17,000$0$197,518$0$17,762$0$457,503$0$0$0
LAURENCE GROSS
SENIOR PROGRAM ADMINISTRATOR$211,863$10,000$0$34,014$0$23,526$0$279,403$0$0$0
MARY LIVINGSTON
MANAGER, HEALTH CLAIMS$147,258$17,000$0$112,765$0$4,392$0$281,415$0$0$0
PAMELA LYNCH
MANAGER, ACCOUNTING/HR$190,647$15,000$0$45,367$0$25,876$0$276,890$0$0$0
WILLIAM MARTIN
MANAGER, IT$173,135$15,000$0$35,997$0$23,126$0$247,258$0$0$0
LYNN CHANG
MANAGER, IT$170,194$15,000$0$181,074$0$18,206$0$384,474$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART II, COLUMN CFormAndLineReferenceDesc
ExplanationRETIREMENT AND OTHER DEFERRED COMPENSATION THE INCREASE IN THE TOTAL PRESENT VALUE OF THE BENEFIT INCREASE COMES PRIMARILY FROM THE INCREASE IN ACCRUALS DURING THE YEAR. ADDITIONALLY, THE DISCOUNT RATE USED AT THE END OF 2019 WAS 3.50%, WHILE THE DISCOUNT RATE USED AT THE END OF 2020 WAS 3.50%. THERE WAS NO EFFECT ON THE LIABILITIES FROM DISCOUNT RATE FLUCTUATION. THESE ARE ACTUARY CALCULATIONS AND THESE AMOUNTS DO NOT REPRESENT A CASH OUTLAY.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6:MEMBERSHIP IN THE CORPORATION SHALL BE OPEN TO INDIVIDUALS WHO ARE ACTIVE EMPLOYEES OF A SAMBA ELIGIBLE EMPLOYING AGENCY OR WHO ARE RETIRED FROM A SAMBA ELIGIBLE EMPLOYING AGENCY, UNDER ANY ESTABLISHED RETIREMENT PROGRAM. THE TERM SAMBA ELIGIBLE EMPLOYING AGENCY MEANS ANY BRANCH, DEPARTMENT OR AGENCY OF THE UNITED STATES GOVERNMENT, INCLUDING WITHOUT LIMITATION, THE US POSTAL SERVICE AND US COURTS. MEMBERSHIP IN THE CORPORATION SHALL CONSIST OF TWO CLASSES: A) REGULAR MEMBERSHIP - ELIGIBLE INDIVIDUALS MAY ELECT REGULAR MEMBERSHIP BY ENROLLING IN THE HEALTH BENEFIT PLAN. REGULAR MEMBERS ALSO MAY ENROLL IN OTHER PLAN PROGRAMS IN ACCORDANCE WITH AND AS PERMITIED BY THE PLAN DOCUMENTS. REGULAR MEMBERSHIP SHALL TERMINATE CONTEMPORANEOUSLY WITH THE TERMINATION OF THE HEALTH BENEFIT PLAN COVERAGE. MEMBERSHIP AT THAT TIME WILL CONVERT TO ASSOCIATE MEMBERSHIP IF THE INDIVIDUAL REMAINS ENROLLED IN ANY OTHER PLAN PROGRAM. B) ASSOCIATE MEMBERSHIP - ELIGIBLE INDIVIDUALS MAY ELECT ASSOCIATE MEMBERSHIP BY ENROLLING IN A PLAN PROGRAM OTHER THAN THE HEALTH BENEFIT PLAN IN ACCORDANCE WITH AND AS PERMITIED BY THE PLAN DOCUMENTS. ASSOCIATE MEMBERSHIP SHALL TERMINATE CONTEMPORANEOUSLY WITH THE TERMINATION OF PLAN COVERAGE UNLESS THE INDIVIDUAL TRANFERS EMPLOYMENT TO ANOTHER AGENCY, IN WHICH CASE HE OR SHE MAY CONTINUE HIS OR HER ENROLLMENT AND ASSOCIATE MEMBERSHIP WHILE SO EMPLOYED. FOR PERSONS WHO DO NOT MEET THE CRITERIA FOR REGULAR OR ASSOCIATE MEMBERSHIP, THE BOARD OF DIRECTORS MAY IN ITS DISCRETION DEFINE A SPECIAL CLASS OF MEMBERSHIP BY VIRTUE OF (1) EMPLOYMENT OR SERVICE WITH THE CORPORATION, (2) PREVIOUS ENROLLMENT IN A PLAN SPONSORED BY THE CORPORATION, OR (3) SECTION 409 OF THE INDIAN HEALTHCARE IMPROVEMENT ACT (IHCIA), AS INCORPORATED AND AMENDED BY SUBSECTION 10221 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA); ALLOWING INDIAN TRIBES OR TRIBAL ORGANIZATIONS OR URBAN INDIAN ORGANIZATIONS AND THEIR EMPLOYEES TO PURCHASE COVERAGE UNDER THE FEDERAL EMPLOYEES HEALTH BENEFIT PROGRAM OR ANY OTHER SUCCESSOR PROGRAM AS SUCH TERMS ARE DEFINED THEREIN. PERSONS ADMITED AS SPECIAL MEMBERS IN THE CORPORATION SHALL HAVE ALL THE RIGHTS ACCORDED ASSOCIATE MEMBERS AND MAY ENROLL IN A PLAN SPONSORED BY THE CORPORATION IF PERMITIED UNDER APPLICABLE LAW.
FORM 990, PART VI, SECTION A, LINE 7A:Regular Members shall have the right to vote in the election of directors, Except as otherwise expressly stated in the Bylaws or in the Articles of Incorporation. Members, including Regular Members, shall not have the right to vote on any other matter affecting the Corporation, including but not limited to merger, consolidation and dissolution.
FORM 990, PART VI, SECTION B, LINE 11B:THE FORM 990 IS REVIEWED BY BOTH THE CONTROLLER AND EXECUTIVE DIRECTOR BEFORE IT IS FORWARDED TO THE TREASURER FOR FINAL REVIEW AND SIGNATURE.
FORM 990, PART VI, SECTION B, LINE 12C:OFFICERS, DIRECTORS OR TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST; INCLUDING, BUT NOT LIMITED TO EMPLOYMENT AND ANY WORK PERFORMED FOR ANOTHER ORGANIZATION PAID OR UNPAID.
FORM 990, PART VI, SECTION B, LINE 15A:THE BOARD SETS THE COMPENSATION OF THE EXECUTIVE DIRECTOR BASED UPON OUTSIDE RECOMMENDATIONS AND STATISTICAL DATA. THE EXECUTIVE DIRECTOR'S COMPENSATION WAS LAST REVIEWED IN JANUARY 2019. .
FORM 990, PART VI, SECTION C, LINE 19:THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABE UPON REQUEST TO THE PUBLIC. The organization's bylaws are available on its website for anyone to view, with the latest update as of October 22, 2012.
FORM 990, PART XI, LINE 9:OTHER CHANGES TO NET ASSETS OR FUND BALANCE OF ($14,069,196) CONSISTS OF THE FOLLOWING: INCREMENTAL EFFECT OF FASB ASC TOPIC 715 - POST RETIREMENT BENEFITS OF $1,453,107, RETURN OF EXCESS RESERVES ($22,529,424), SPECIAL RESERVE OF $7,007,121.
FORM 990, PART VII, SECTION A, COLUMN F:ESTIMATED AMOUNT OF OTHER COMPENSATION THE INCREASE IN THE TOTAL PRESENT VALUE OF THE BENEFIT INCREASE COMES PRIMARILY FROM THE INCREASE IN ACCRUALS DURING THE YEAR. ADDITIONALLY,THE DISCOUNT RATE USED AT THE END OF 2019 WAS 3.50%, WHILE THE DISCOUNT RATE USED AT THE END OF 2020 WAS 3.50%. THERE WAS NO EFFECT ON THE LIABILITIES FROM DISCOUNT RATE FLUCTUATION. THESE ARE ACTUARY CALCULATIONS AND THESE AMOUNTS DO NOT RESPRESENT A CASH OUTLAY.
FORM 990, PART XII, LINE 1:BASIS OF PRESENTATION THIS TAX RETURN COMBINES TWO PLANS OF THE ENTITY. THE FINANCIAL STATEMENTS OF THE BENEFIT PLAN ARE IN ACCORDANCE WITH GAAP. THE FINANCIAL STATEMENTS OF THE HEALTH PLAN ARE PREPARED PURSUANT TO THE U.S. OFFICE OF PERSONNEL MANAGEMENT'S (OPM) PRESCRIBED ACCOUNTING PRACTICES FOR FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM ("FEHBP") CARRIERS AND IS NOT INTENDED TO BE A COMPLETE PRESENTATION IN ACCORDANCE WITH GAAP. IN ACCORDANCE WITH OPM'S PRESCRIBED ACCOUNTING PRACTICES, EXPENSES ARE ONLY RECOGNIZED AND PAID BY THE HEALTH PLAN IF ALLOWED UNDER THE U.S. GOVERNMENT'S COST ACCOUNTING STANDARDS AND OTHER LIMITATIONS IMPOSED BY THE CONTRACT WITH OPM. IN THIS REGARD, SOME EXPENSES NOT ALLOWED BY THE HEALTH PLAN ARE CHARGED AS MISCELLANEOUS EXPENSES OF THE BENEFIT PLAN.

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