2018-11-14T15:30:20-06:00 2017-12-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-01-01 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 2018-11-14 1 TROY ATKINSON P00739466 9094664410 65.60.100.226 2018-11-14 13:26:41 PS P C8485762D0A103083B9EABF22E0AFFE603142D80 A8923EACCE2D6A4F1290DCBC04922AB836540ED7 2017 2019-02-21 02:37:17Z 4010 TRUXEL ROAD SACRAMENTO CA 95834 13919486 0 X N/A X 1991 CA SEE PART III LINE 4A 11 11 0 0 0 0 0 0 5847905 5908672 118489 139307 2579958 1917719 8546352 7965698 0 0 6079300 5048645 0 0 0 0 0 1600856 1663266 7680156 6711911 866196 1253787 6461647 7381766 2977394 2394888 3484253 4986878 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. 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 23 0 0 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 958343725 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 MICHAEL BOYD TRUSTEE 5.00 X 0 0 0 BILL DANIELS 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 FRANCE TRUSTEE 5.00 X 0 0 0 BRENT MEYER TRUSTEE 5.00 X 0 0 0 SHANE TALBOT TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 PORAC 4010 TRUXEL ROAD SACRAMENTO CA 95834 ADMINISTRATOR 682136 MYER-STEVENS TOOHEY 26101 MARGUERITE PARKWAY MISSION VIEJO CA 92692 PROVIDER 472032 REICH ADDELL AND CVITAN 3550 WILSHIRE BLVD SUITE 2000 LOS ANGELES CA 90010 LEGAL 138393 3 PARTICIPANT CONTRIBUTIONS 900099 5908672 5908672 5908672 139307 139307 5953788 5953788 0 ADMIN FEE REVENUE 900099 1000419 1000419 LTD CLAIMS RECOVERIES 900099 858670 858670 OTHER 900099 57980 57980 650 650 1917719 7965698 7826391 0 139307 5048645 1201160 162080 29500 16797 59539 61561 2854 34258 CONSULTANT 91760 MISCELLANEOUS 3757 6711911 127103 826002 1421231 644 776224 390205 36871 52052 56471 31061 4355 25410 2604544 4763540 1491319 1323913 6461647 7381766 186149 229844 2791245 2165044 2977394 2394888 X 0 0 0 0 3484253 4986878 3484253 4986878 6461647 7381766 1253787 248838 0 X X 0 1 X 1 0 56471 31061 25410 25410 ESTIMATED RECOVERABLE CLAIMS RECEIVABLE 1114220 ADMINISTRATIVE FEE RECEIVABLE 161975 DUE FROM OTHER TRUSTS 47718 1323913 ACCRUED VACATION/PAYROLL TAXES 31279 GROUP INSURANCE PREMIUMS PAYABLE 196182 SELF-FUNDED BENEFITS CLAIMS PAYABLE 1076000 INCURRED BUT NOT REPORTED CLAIMS 784000 DUE TO OTHER TRUST 77583 2165044 X 8214536 248838 248838 7965698 0 7965698 6711911 0 6711911 0 6711911 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. 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.