2016-05-12T11:11:19-05:00 2015-06-30 300702322 HEMMING MORSE 155 BOVET ROARD SUITE 600 SAN MATEO CA 94402 990 2014-07-01 926027877 PUBLIC EDUCATION HEALTH TRUST PUBL 9072747526 4003 IOWA DRIVE ANCHORAGE AK 99517 TRUSTEE TRUSTEE TRUSTEE 9072747526 2016-05-12 1 P00739466 4158364000 2014 2016-08-17 19:52:53Z 4003 IOWA DRIVE ANCHORAGE AK 99517 112459999 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 116917381 110345957 1631381 1402964 280682 711078 118829444 112459999 0 0 116680547 120140514 390616 423750 0 0 0 4694776 5945366 121765939 126509630 -2936495 -14049631 39695832 25220911 14401142 15251692 25294690 9969219 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 0 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 KATHY 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 161750 0 43318 161750 0 43318 1 0 1 0 EBMS PO BOX 21367 BILLINGS MT 59104 TPA FEES 2211012 EBMS PO BOX 21367 BILLINGS MT 59104 UTILIZATION REVIEW 1095756 THE WILSON AGENCY 3000 A STREET SUITE 400 ANCHORAGE AK 99503 CORE SERVICE FEES 240000 VSP ADMIN 121 SW MORRISON STE 1050 PORTLAND OR 97024 VISION SERVICE ADMINISTRATION FEES 162575 FIRST CHOICE HEALTH 600 UNIVERSITY ST SUITE 1400 SEATTLE WA 98101 HEALTH ADMINISTRATION FEES 149819 5 EMPLOYER CONTRIBUTIONS 900099 106657267 106657267 PARTICIPANT CONTRIBUTIONS 900099 3688690 3688690 110345957 1191492 1191492 211472 0 211472 211472 211472 MISCELLANEOUS 900099 711078 711078 711078 112459999 111057035 0 1402964 120140514 161750 110866 94357 37525 19252 33893 25000 212028 34999 6836 4793 2951 28257 FEES PAID TO THIRD PART 4395304 STOP-LOSS INSURANCE PRE 437403 CORE SERVICE FEES 240000 MARKETING EXPENSE 167420 356482 126509630 64430 90080 5724357 4138460 302880 313341 59519 39619 10531 19900 33581354 20491587 12280 167543 39695832 25220911 14401142 15251692 14401142 15251692 X 0 0 0 0 25294690 9969219 25294690 9969219 39695832 25220911 -14049631 -1275840 0 X X 0 1 X 1 0 59519 39619 19900 19900 OTHER 41357 INCURRED BUT NOT REPORTED 14817000 UNEARED REVENUE 393335 15251692 111184159 -1275840 -1275840 112459999 0 112459999 126509630 0 126509630 0 126509630 X 0 0 0 RHONDA KITTER CHIEF FINANCIAL OFFICER 161750 0 0 0 0 0 37525 0 5793 0 205068 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 AT THE FALL MEETING. 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. SOUTHEAST ISLAND SCHOOL DISTRICT PO BOX 19569 THRONE BAY AK 99919 920057120 SCHOOL DISTRICT AK 0 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 ALASKA GATEWAY EDUCATION ASSOC. 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 JUNEAU SCHOOL - DISTRICT EXEMPT JUNEAU SCHOOLS ADMINISTRATION ASSOC. KAKE SCHOOL DISTRICT MAT-SU BOROUGH SCHOOL DISTRICT MAT-SU EDUCATION ASSOC. NEA-ALASKA MANAGEMENT NEA-ALASKA NSO NENANA CITY PUBLIC SCHOOLS PETERSBURG SCHOOL DISTRICT PRIBILOF SCHOOL DISTRICT SOUTHEAST ISLAND SD WRANGELL PUBLIC SCHOOLS