2017-05-12T16:50:33-05:00 2016-06-30 300702322 HEMMING MORSE 155 BOVET ROARD SUITE 600 SAN MATEO CA 94402 990 2015-07-01 926027877 PUBLIC EDUCATION HEALTH TRUST PUBL 9072747526 4003 IOWA DRIVE ANCHORAGE AK 99517 RHONDA KITTER CHIEF FINANCIAL OFFICER 9072747526 2017-05-12 1 P00739466 4158364000 2015 2021-01-29 14:40:06Z 4003 IOWA DRIVE ANCHORAGE AK 99517 112319523 0 X N/A X 1996 AK TO PROVIDE COMPREHENSIVE MEDICAL, DENTAL, VISION, AND PRESCRIPTION DRUG BENEFITS. 7 7 3 0 0 0 0 0 110345957 111104231 1402964 457043 711078 758249 112459999 112319523 0 0 120140514 121094848 423750 419347 0 0 0 5945366 5713877 126509630 127228072 -14049631 -14908549 25220911 12483772 15251692 18308397 9969219 -5824625 NONE. 0 0 TO PROVIDE COMPREHENSIVE MEDICAL, DENTAL, VISION, AND PRESCRIPTION DRUG BENEFITS. 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 1 0 0 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X RHONDA KITTER 9072747526 4003 IOWA DRIVE ANCHORAGE AK 99517 TIM WALTERS TRUSTEE 5.00 X 0 0 0 JESSICA COOK TRUSTEE 5.00 X 0 0 0 KATHLEEN BELL TRUSTEE 5.00 X 0 0 0 RON FUHRER TRUSTEE 5.00 X 0 0 0 KERI CLARK TRUSTEE 5.00 X 0 0 0 JOSH ANDREWS TRUSTEE 5.00 X 0 0 0 STEPHEN BYERS TRUSTEE 5.00 X 0 0 0 RHONDA KITTER CHIEF FINANCIAL OFFICER 40.00 X 158982 0 43311 158982 0 43311 1 0 1 0 EBMS PO BOX 21367 BILLINGS MT 59104 TPA FEES 2448007 EBMS PO BOX 21367 BILLINGS MT 59104 UTILIZATION REVIEW 977329 THE WILSON AGENCY 3000 A STREET SUITE 400 ANCHORAGE AK 99503 CORE SERVICE FEES 246000 VSP ADMIN 121 SW MORRISON STE 1050 PORTLAND OR 97024 VISION SERVICE ADMINISTRATION FEES 166602 AMERCAN HEALTH HOLDINGS 7400 W CAMPUS RD F-510 NEW ALBANY OH 43054 MANAGED HEALTH ADMIN FEE 151400 6 EMPLOYER CONTRIBUTIONS 900099 108159654 108159654 PARTICIPANT CONTRIBUTIONS 900099 2944577 2944577 111104231 372474 372474 84569 0 84569 84569 84569 MISCELLANEOUS 900099 758249 758249 758249 112319523 111862480 0 457043 121094848 158982 106862 97094 37518 18891 94002 25550 86712 65676 34088 4005 11430 4022 30044 FEES PAID TO THIRD PART 3837932 ACA TRANSITIONAL REINSU 550210 STOP-LOSS INSURANCE PRE 381902 CORE SERVICE FEES 246000 342304 127228072 90080 78236 4138460 2370513 313341 329947 59519 43640 19900 15879 20491587 9508484 167543 180713 25220911 12483772 15251692 18308397 15251692 18308397 X 0 0 0 0 9969219 -5824625 9969219 -5824625 25220911 12483772 -14908549 -885295 0 X X 0 1 X 1 0 59519 43640 15879 15879 OTHER 59621 INCURRED BUT NOT REPORTED 16288000 UNEARED REVENUE 244757 CLAIMS FOR BENEFITS 1716019 18308397 X 111434228 -885295 -885295 112319523 0 112319523 127228072 0 127228072 0 127228072 PART X, LINE 2: THE PLAN HAS ADOPTED GUIDANCE, ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD, ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE PLAN BELIEVES THAT THE PLAN HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. THE PLAN BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS PRIOR TO JUNE 30, 2013. X 0 0 0 RHONDA KITTER CHIEF FINANCIAL OFFICER 158982 0 0 0 0 0 37518 0 5793 0 202293 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C POLICY IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990. PART XI, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. VARIOUS - SEE SUPPLEMENTAL INFORMATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART IV, LINE 34 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ENTITY IS A 501(C)(9) VEBA WHO MUST LIST CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE ADMINISTRATIVE OFFICE MAINTAINS A LIST OF CONTRIBUTIONS EMPLOYERS, HOWEVER, THAT LIST DOES NOT INCLUDE FEDERAL TAX CLASSIFICATION. THEREFORE, THE LIST OF CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. ALASKA GATEWAY SCHOOL DISTRICT ANCHORAGE EDUCATION ASSOC. BRISTOL BAY SCHOOL DISTRICT CHATHAM SCHOOL DISTRICT CLASSIFIED EMPLOYEE ASSOC. COPPER RIVER SCHOOL DISTRICT CORDOVA SCHOOL DISTRICT CRAIG SCHOOL DISTRICT DENALI BOROUGH SCHOOL DISTRICT DELTA/GREELY SCHOOL DISTRICT HAINES BOROUGH SCHOOL DISTRICT HYDABURG SCHOOL DISTRICT JUNEAU EDUCATION ASSOC. JUNEAU SCHOOL DISTRICT KAKE SCHOOL DISTRICT MAT-SU BOROUGH SCHOOL DISTRICT MAT-SU EDUCATION ASSOC. NEA-ALASKA MANAGEMENT NENANA CITY PUBLIC SCHOOLS PETERSBURG SCHOOL DISTRICT PRIBILOF SCHOOL DISTRICT SOUTHEAST ISLAND SD WRANGELL PUBLIC SCHOOLS