2015-05-12T12:44:52-05:00 2014-12-31 BOND BEEBE PC 4600 EAST-WEST HIGHWAY SUITE 900 BETHESDA MD 208143423 990 2014-01-01 521074154 SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATION % JOHN MARTUCCI SPEC 3019841440 11301 OLD GEORGETOWN ROAD Suite ROCKVILLE MD 20852 KATHRYN DIEM TREASURER 3019841440 2015-05-06 true JOHN A MERCHANT P00172288 3019841440 2014 2016-03-07 17:11:31Z KATHRYN DIEM 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 312002749 false X WWW.SAMBAPLANS.COM X 1976 DC TO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN FOR ITS MEMBERSHIP. 6 6 73 0 0 0 0 258737582 264950579 4368168 5590192 2361 1085 263108111 270541856 6010 6010 217575715 234949551 6904284 7084558 0 0 0 14542801 18747906 239028810 260788025 24079301 9753831 165015942 170796291 30436892 36999046 134579050 133797245 TO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN ("THE PLAN") FOR ITS MEMBERSHIP IN ACCORDANCE WITH ERISA. THE SAMBA BENEFIT PLAN INCLUDES HEALTH, LIFE, SICK, 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 18 0 true 73 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 3019844410 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 X JOSEPH R DAVIS BOARD MEMBER 1.0 0.0 X 2000 0 0 KATHRYN DIEM TREASURER/BOARD MEMBER 1.0 0.0 X X 2000 0 0 DAVID R LOESCH VICE PRESIDENT/BOARD MEMBER 1.0 0.0 X X 2000 0 0 WILLIAM P O'HANLON PRESIDENT/BOARD MEMBER 4.0 0.0 X X 46000 0 0 CHARLENE B THORNTON BOARD MEMBER 1.0 0.0 X 2000 0 0 ANGELA ZENTZ DIRECTOR 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 471195 0 131018 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 40.0 0.0 X 203434 0 268808 JOHN R MARTUCCI CONTROLLER 40.0 0.0 X 169744 0 256467 M TODD SCHOENIAN SENIOR PROGRAM ADMINISTRATOR 40.0 0.0 X 152694 0 206683 MARY LIVINGSTONE MANAGER, HEALTH PLANS 40.0 0.0 X 132639 0 68484 PAMELA LYNCH MANAGER ACCOUNTING/HR 40.0 0.0 X 119998 0 120100 LYNN CHANG MANAGER IT 40.0 0.0 X 119883 0 149382 WILLIAM MARTIN NETWORK ADMINISTRATOR 40.0 0.0 X 114434 0 31877 1538021 0 1232819 11 false true false CIGNA HEALTHCARE 1111 MARKET STREET CHATTANOOGA TN 37402 health network admin 93108034 CVS CAREMARK HEALTH 9501 E SHEA BLVD SCOTTSDALE AZ 85260 pharmacy benefit mgr 1005473 EBS MASTER LLC 3055 LEBANON ROAD SUITE 1000 NASHVILLE TN 37214 printing & mailing 799676 AETNA LIFE INSURANCE CO 151 FARMINGTON AVENUE HARTFORD CT 06156 DENTAL NETWORK ADMIN 536365 IHN INC SAGAMORE 11595 N MERIDIAN STREET STE 600 CARMEL IN 46032 CLAIMS NEGOTIATION 507621 15 0 PREMIUMS 525100 260932230 260932230 ADMINISTRATION FEES 525100 3861491 3861491 EXPERIENCE RATING ADJUSTMENTS 525100 156858 156858 264950579 1678249 1678249 0 0 0 0 0 45372836 41460893 3911943 3911943 3911943 0 0 0 MISCELLANEOUS 900099 1085 1085 1085 270541856 264950579 5591277 6010 0 0 234949551 942729 0 4104433 776883 907893 352620 0 63373 172174 0 0 246651 8251005 0 1537157 1407070 0 136991 43860 0 0 0 0 1051551 108030 REINSURANCE EXPENSE 3599352 TRANSITIONAL REINSURANCE FEE 1542744 TAXES - PROPERTY 73236 PCORI EXCISE TAX 72234 442478 260788025 500 500 69549342 66481960 0 0 20801791 21240824 0 0 0 0 0 0 0 0 354090 505984 13054232 10874630 2637765 2179602 70961191 79658873 0 0 0 0 0 0 711263 728548 165015942 170796291 765852 2309865 0 0 823757 805257 0 0 0 0 0 0 0 0 0 0 28847283 33883924 30436892 36999046 X 134579050 133797245 0 0 0 0 134579050 133797245 165015942 170796291 X 9753831 764682 -11300318 X false true X true false 600000 600000 4418542 4130348 288194 7642827 6365028 1277799 392863 379254 13609 2179602 0 RESERVE FOR UNPAID CLAIMS 24695659 ACCRUED PENSION LIABILITY 5048444 GROUP INSURANCE PREMIUM PAYABL 2259297 PROVISION FOR POSTRETIREMENT 1155326 RESERVE IN EXCESS OF FUNDS 725198 33883924 X 273527861 764682 2221323 2986005 270541856 270541856 263009348 2221323 2221323 260788025 260788025 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, 2014 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 $2,221,323 PART XII, LINE 2D - OTHER EXPENSES INCLUDED ON F/S, NOT ON RETURN: INTERPLAN ALLOCATIONS $2,221,323 X X X false false false WALTER E WILSON EXECUTIVE DIRECTOR 338697 0 124966 7532 117638 0 13380 0 602213 0 0 0 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 178434 0 25000 255486 0 13322 0 472242 0 0 0 JOHN R MARTUCCI CONTROLLER 161244 0 8500 248995 0 7472 0 426211 0 0 0 M TODD SCHOENIAN SENIOR PROGRAM ADMINISTRATOR 142694 0 10000 198251 0 8432 0 359377 0 0 0 MARY LIVINGSTONE MANAGER, HEALTH PLANS 122639 0 10000 52662 0 15822 0 201123 0 0 0 PAMELA LYNCH MANAGER ACCOUNTING/HR 112498 0 7500 103185 0 16915 0 240098 0 0 0 LYNN CHANG MANAGER IT 110383 0 9500 133141 0 16241 0 269265 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 ADMITIED 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 IV, 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 2014. FORM 990, PART IV, 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 their website for anyone to view, with the lastest update as of October 1, 2012. FORM 990, PART XI, LINE 9: OTHER CHANGES TO NET ASSETS OR FUND BALANCE OF $(11,300,318) CONSISTS OF THE FOLLOWING: INCREMENTAL EFFECT OF FASB 158 $(2,222,550) CONTIGENCY RESERVE PAYMENT OF $(9,077,768)