2018-11-16T14:28:52-06:00 2017-12-31 990 2017-01-01 521074154 SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATION % JOHN MARTUCCI SPEC 3019841440 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 KATHRYN DIEM TREASURER & DIRECTOR 3019844110 2018-11-12 71.178.173.242 22006220183205000011 2018-11-16 P E40306692C2C6A06F94A97DAF988C1E7AC780985 CC23FAD342CE2237571F1D3AA461D45029E114EC 2017 2019-02-21 02:37:17Z KATHRYN DIEM 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 386681081 false X WWW.SAMBAPLANS.COM X 1976 DC TO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN FOR ITS MEMBERSHIP. 6 6 67 0 0 0 0 291249019 319733022 2859281 3809856 296171 797704 294404471 324340582 6010 6000 299604404 298808451 8801807 9544689 0 0 0 15766075 16251707 324178296 324610847 -29773825 -270265 163507383 195950616 66985186 80327064 96522197 115623552 TO 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. false false SPONSORED HEALTH, GROUP TERM LIFE, DISABILITY, ACCIDENT, DENTAL AND VISION BENEFITS FOR APPROXIMATELY 111,000 MEMBERS. false false false false false false false false false true false false false true true true false false false false false false false false false false false false true false false false false false false false false false false false false false false true 22 0 true 67 true false false false false false false X 6 6 false false false false true true false true true false false false true true true true true true false false X JOHN MARTUCCI 3019844110 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 X WILLIAM P O'HANLON PRESIDENT/BOARD MEMBER 4.0 0.0 X X 46000 0 0 DAVID R LOESCH VICE PRESIDENT/BOARD MEMBER 1.0 0.0 X X 2000 0 0 KATHRYN DIEM TREASURER/BOARD MEMBER 1.0 0.0 X X 2000 0 0 JOSEPH R DAVIS BOARD MEMBER 1.0 0.0 X 2000 0 0 CHARLENE B THORNTON BOARD MEMBER 1.0 0.0 X 2000 0 0 ANGELA ZENTZ BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID ERMER SECRETARY 1.0 0.0 X 0 0 0 WALTER E WILSON EXECUTIVE DIRECTOR 40.0 0.0 X 525745 0 141887 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 40.0 0.0 X 259196 0 209650 JOHN R MARTUCCI CONTROLLER 40.0 0.0 X 199980 0 251552 M TODD SCHOENIAN SENIOR PROGRAM ADMINISTRATOR 40.0 0.0 X 162619 0 276775 MARY LIVINGSTON MANAGER, HEALTH PLANS 40.0 0.0 X 162435 0 105393 PAMELA LYNCH MANAGER, ACCOUNTING/HR 40.0 0.0 X 162188 0 91394 WILLIAM MARTIN NETWORK ADMINISTRATOR 40.0 0.0 X 149012 0 52102 LYNN CHANG MANAGER, IT 40.0 0.0 X 143164 0 117378 1818339 0 1246131 14 false true false CIGNA HEALTHCARE 1111 MARKET STREET CHATTANOOGA TN 37402 HEALTH NETWORK ADMIN 6545625 EXPRESS SCRIPTS HLD CO 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 PHARMACY BENEFIT MGR 2039314 CHANGE HEALTHCARE 3055 LEBANON PIKE SUITE 1000 NASHVILLE TN 37214 PRINTING & MAILING 877499 MAINLINE INFORMATION SYSTEMS 1700 SUMMIT LAKE DR TALLAHASSEE FL 32317 SOFTWARE MAINTENANCE 528091 MEDICAL RISK MANAGERS PO BOX 1962 FREDERICK MD 21702 CLAIMS NEGOTIATION 523258 14 0 PREMIUMS 525100 312879900 312879900 ADMINISTRATION FEES 525100 3942477 3942477 EXPERIENCE RATING ADJUSTMENT 525100 2904180 2904180 CARRIER INVESTMENT INCOME 525100 6465 6465 319733022 2106503 2106503 0 0 0 0 0 0 0 64043852 62340499 1703353 1703353 1703353 0 0 0 0 0 0 0 0 0 MISCELLANEOUS 900099 797704 797704 797704 324340582 319733022 4607560 6000 0 0 298808451 1117604 0 4598061 1408781 2020064 400179 0 64585 199398 0 0 278886 11097316 0 1645947 1364926 0 229165 47750 0 0 585 0 620808 129548 CAS ALLOWANCE 401342 TAXES - PROPERTY 78634 PCORI EXCISE TAX 90031 MISCELLANEOUS 2786 324610847 500 500 43610567 54562554 0 0 23998559 25692141 0 0 0 0 0 0 0 0 618297 536235 14049866 11400533 2563535 2649333 90959761 108796885 0 0 0 0 0 0 1756164 3712968 163507383 195950616 1124280 1145964 0 0 620293 0 0 0 0 0 0 0 0 0 0 0 65240613 79181100 66985186 80327064 X 0 0 0 0 96522197 115623552 96522197 115623552 163507383 195950616 X -270265 5495146 13876474 X false true X true false 0 600000 600000 0 5626634 4316638 1309996 0 0 0 0 0 7379328 6680203 699125 443904 403692 40212 2649333 0 SPECIAL RESERVE - OPM 40023531 RESERVE FOR UNPAID CLAIMS 32209225 ACCRUED PENSION LIABILITY 406325 GROUP INSURANCE PREMIUM PAYABLE 2570143 PROVISION FOR POST RETIREMENT 2260707 RESERVE IN EXCESS OF FUNDS - FSL 1000000 OTHER LIABILITIES 711169 79181100 X 332518346 5495146 2682618 8177764 324340582 324340582 327293465 2682618 2682618 324610847 324610847 PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE: U.S. generally accepted accounting principles require 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, 2017, 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. PART XI, LINE 2D - OTHER REVENUES ON AUDITED F/S, NOT ON RETURN: INTERPLAN ALLOCATIONS $ 2,682,618 PART XII, LINE 2D - OTHER EXPENSES ON AUDITED F/S, NOT ON RETURN: INTERPLAN ALLOCATIONS $ 2,682,618 X X X false false false WALTER E WILSON EXECUTIVE DIRECTOR 377540 0 143053 0 5152 0 126625 0 15262 0 667632 0 0 0 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 214196 0 45000 0 0 0 190883 0 18767 0 468846 0 0 0 JOHN R MARTUCCI CONTROLLER 184980 0 15000 0 0 0 230185 0 21367 0 451532 0 0 0 M TODD SCHOENIAN SENIOR PROGRAM ADMINISTRATOR 147619 0 15000 0 0 0 266395 0 10380 0 439394 0 0 0 MARY LIVINGSTON MANAGER, HEALTH PLANS 147435 0 15000 0 0 0 84076 0 21317 0 267828 0 0 0 PAMELA LYNCH MANAGER, ACCOUNTING/HR 147188 0 15000 0 0 0 69523 0 21871 0 253582 0 0 0 WILLIAM MARTIN NETWORK ADMINISTRATOR 134012 0 15000 0 0 0 32831 0 19271 0 201114 0 0 0 LYNN CHANG MANAGER, IT 131164 0 12000 0 0 0 95507 0 21871 0 260542 0 0 0 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 2017. 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 1, 2012. FORM 990, PART XI, LINE 9: OTHER CHANGES TO NET ASSETS OR FUND BALANCE OF $13,876,474 CONSISTS OF THE FOLLOWING: INCREMENTAL EFFECT OF FASB ASC TOPIC 715 - POST RETIREMENT BENEFITS OF $2,177,600 CONTINGENCY RESERVE PAYMENT OF $32,876,072 SPECIAL RESERVE OF ($21,177,198)