2019-11-15T18:57:47-06:00 2018-12-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2018-01-01 686068469 INSURANCE AND BENEFITS TRUST OF THE PEACE OFFICERS RESEARCH ASSOC OF CA INSU 9169283777 4010 TRUXEL ROAD SACRAMENTO CA 95834 TRUSTEE TRUSTEE TRUSTEE 9169283777 2019-11-15 1 TERRI MONTGOMERY P00232100 9254804000 216.147.181.51 2019-11-15 18:57:43 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F52D36390EBCF6BF15030359CEDEDEC3AB6B140A 2018 2020-03-31 21:24:44Z 4010 TRUXEL ROAD SACRAMENTO CA 95834 266955611 0 X N/A X 1991 CA SEE PART III LINE 4A 11 11 20 0 0 0 0 0 5908672 192693017 139307 1574847 1917719 52040105 7965698 246307969 0 0 5048645 171349040 0 0 0 0 0 1663266 14856702 6711911 186205742 1253787 60102227 7381766 83565966 2394888 20213774 4986878 63352192 NONE 0 0 TO PROVIDE DISABILITY, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, CANCER, ACCIDENT AND HOSPITAL BENEFITS TO 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 AN INSURED BENEFIT PLAN FOR THIS BENEFIT THAT WERE NOT IN TRUST. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14 0 20 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 X JOEY SCHLEMMER TRUSTEE 5.00 X 0 0 0 FRANCO VADO TRUSTEE 5.00 X 0 0 0 DAMON KURTZ TRUSTEE 5.00 X 0 0 0 ISRAEL REYES TRUSTEE 5.00 X 0 0 0 PAT MCNELIS TRUSTEE 5.00 X 0 0 0 CODY GREEN TRUSTEE 5.00 X 0 0 0 RUSTY REA TRUSTEE 5.00 X 0 0 0 RICHARD BUSS 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 0 0 0 0 0 0 0 ANTHEM BLUE CROSS 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 6956758 MEDICARE 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 ADMINISTRATOR 4471482 INSURANCE BENEFIT TRUST OF PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 756966 PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 696172 MYER-STEVENS TOOHEY 26101 MARGUERITE PARKWAY MISSION VIEJO CA 92692 PROVIDER 472743 5 PREMIUM CONTRIBUTIONS REVENUE 900099 184372250 184372250 PARTICIPANT CONTRIBUTIONS 900099 8320767 8320767 192693017 1574847 1574847 20647642 20647642 0 OTHER 900099 49847831 49847831 ADMIN FEE REVENUE 900099 1120148 1120148 LTD CLAIMS RECOVERIES 900099 1071520 1071520 606 606 52040105 246307969 244733122 0 1574847 171349040 1971710 185941 35777 186712 12113315 77134 49258 13490 51318 ACA INSURER 144249 MISCELLANEOUS 18175 SUPPLIES AND TELEPHONE 9623 186205742 826002 15236574 644 103058 390205 14011826 52052 79658 60233 44519 25410 15714 4763540 47944838 1323913 6174298 7381766 83565966 229844 4111375 2165044 16102399 2394888 20213774 X 0 0 0 0 4986878 63352192 4986878 63352192 7381766 83565966 60102227 -1736913 0 X X 0 1 X 1 0 60233 44519 15714 15714 ESTIMATED RECOVERABLE CLAIMS RECEIVABLE 1449930 ADMINISTRATIVE FEE RECEIVABLE 9055 DUE FROM OTHER TRUSTS 434870 PRESCRIPTION REBATES RECEIVABLE 3578439 STOP LOSS RECEIVABLE 529168 ACCRUED INTEREST AND DIVIDENDS 172836 6174298 ACCRUED VACATION/PAYROLL TAXES 41939 GROUP INSURANCE PREMIUMS PAYABLE 2937665 SELF-FUNDED BENEFITS CLAIMS PAYABLE 608000 INCURRED BUT NOT REPORTED CLAIMS 12030713 DUE TO OTHER TRUST 484082 16102399 X 244384344 -1736913 -1736913 246121257 186712 186712 246307969 172498834 0 172498834 186712 13520196 13706908 186205742 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 13,520,196. 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 MAILED THE FORM AND ASKED TO REMARK IF THEY HAVE ANY CHANGES. THE AUDIT FIRM ATTENDS THE SEPTEMBER MEETING AND REVIEWS THE FORM 990 WITH THE TRUSTEES. 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.