2020-11-16T14:22:01-06:00 2019-12-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2019-01-01 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 2020-11-16 1 THERESA MONTGOMERY CPA P00232100 9254804000 2020-11-09 99.110.55.147 2020-11-16 14:21:48 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 327E456370A643C83A1BB4325D39191A230D016A 2019 2021-04-22 16:20:28Z FRANCO VADO 4010 TRUXEL ROAD SACRAMENTO CA 95834 232687305 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 0 0 0 0 192693017 175111776 1574847 2180336 52040105 28611314 246307969 205903426 0 0 171349040 192554828 0 0 0 0 0 14856702 11523802 186205742 204078630 60102227 1824796 83565966 98196410 20213774 30034115 63352192 68162295 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 0 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 0 0 0 1 13 0 1 12 1 0 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 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 JOEY SCHLEMMER TRUSTEE 5.00 X 0 0 0 DAMON KURTZ TRUSTEE 5.00 X 0 0 0 PATRICK MARTIN OCT-DEC 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 MARIA JIMENEZ CHIEF OPERATIONS OFFICER 40.00 X 0 155764 8012 0 155764 8012 0 0 1 0 ANTHEM BLUE CROSS 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 6140250 MEDICARE 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 1787125 PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 908798 INSURANCE BENEFIT TRUST OF PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 669896 MYER-STEVENS TOOHEY 26101 MARGUERITE PARKWAY MISSION VIEJO CA 92692 PROVIDER 511876 7 PARTICIPANT CONTRIBUTIONS 900099 166865714 166865714 PREMIUM CONTRIBUTIONS REVENUE 900099 8246062 8246062 175111776 1911496 1911496 27052719 26783879 268840 268840 268840 OTHER 900099 27143600 27143600 ADMIN FEE REVENUE 900099 867195 867195 LTD CLAIMS RECOVERIES 900099 600219 600219 300 300 28611314 205903426 203723090 0 2180336 192554828 2090570 174933 33509 267984 8568247 52466 75836 9356 73429 ACA INSURER 79546 PCORI FEE 41557 SUPPLIES AND TELEPHONE 37945 PRINTING 9330 9094 204078630 15236574 11913175 103058 5649972 14011826 13781534 79658 89953 136809 21262 15714 115547 47944838 65098664 6174298 1547565 83565966 98196410 4111375 12898767 16102399 17135348 20213774 30034115 X 0 0 0 0 63352192 68162295 63352192 68162295 83565966 98196410 1824796 2985307 0 X X 0 1 X 1 0 103419 103419 33390 21262 12128 115547 ACCRUED VACATION/PAYROLL TAXES 43968 GROUP INSURANCE PREMIUMS PAYABLE 2956244 SELF-FUNDED BENEFITS CLAIMS PAYABLE 1341386 INCURRED BUT NOT REPORTED CLAIMS 12779000 DUE TO OTHER TRUST 14750 17135348 X 208620749 2985307 2985307 205635442 267984 267984 205903426 202310394 0 202310394 267984 1500252 1768236 204078630 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 1,500,252. 0 0 0 MARIA JIMENEZ CHIEF OPERATIONS OFFICER 0 155764 0 0 0 0 0 0 0 8012 0 163776 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 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. 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.