2015-04-15T13:01:48-07:00 2014-06-30 990 2013-07-01 521588740 PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND PENN 7175657318 150 SOUTH 43RD STREET SUITE 1 HARRISBURG PA 171115700 Robert Bickford Chief Financial Officer 7175657318 2015-04-14 2013 2016-03-07 17:11:31Z Kathryn Farley PEBTF 150 South 43rd Street Harrisburg PA 17111 1336228386 0 X pebtf.org X Non-profit 1988 PA Trust for the provision of medical, surgical, hospital and supplemental benefits to employees of the Commonwealth of Pennsylvania and associated Agencies, as well as their dependents and retirees. 18 18 141 18 0 0 0 0 900541239 978436458 1040179 854678 0 0 901581418 979291136 0 0 889548737 926603220 4512492 4814538 0 0 0 42641835 36498863 936703064 967916621 -35121646 11374515 393409563 401282958 112079892 107241575 281329671 294041383 Trust for the provision of medical, surgical, hospital and supplemental benefits to employees of the Commonwealth of Pennsylvania and associated Agencies, as well as their dependents and retirees. 0 0 0 0 0 To provide medical, surgical, hospital and supplemental benefits to employees of the Commonwealth of Pennsylvania as well as other participants. Benefits provided to approximately 74,000 contracts or 180,000 covered lives. 0 0 0 0 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 0 0 0 1 93 0 1 141 1 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 0 X Robert Bickford 7175657318 150 S 43rd Street Suite 1 Harrisburg PA 171115700 David Fillman Chairman 0.38 0 X 0 0 0 Richard Caponi Board Member 0.13 0 X 0 0 0 Michael Fox Board Member 0.25 0 X 0 0 0 Neal Bisno Board Member 0.25 0 X 0 0 0 Kathy Jellison Board Member 0.25 0 X 0 0 0 Wendell Young IV Board Member 0.25 0 X 0 0 0 Dominic Sgro Board Member 0.25 0 X 0 0 0 William Einhorn Board Member 0.13 0 X 0 0 0 John Guyer Board Member 0.25 0 X 0 0 0 Kelly Powell Logan Secretary 0.38 0 X 0 0 0 James A Honchar Board Member 0.25 0 X 0 0 0 Ann Spishock Board Member 0.13 0 X 0 0 0 Jay Gasdaska Board Member 0.25 0 X 0 0 0 Kari King Board Member 0.13 0 X 0 0 0 Michael Bodinsky Board Member 0.25 0 X 0 0 0 Tara Long Board Member 0.38 0 X 0 0 0 Erika Swaney Board Member 0.25 0 X 0 0 0 Charles Zogby Board Member 0.25 0 X 0 0 0 Kathryn Farley Exec Director/CEO 40 0 X 262115 0 23233 Robert Bickford CFO 40 0 X 137787 0 17601 Nancy Murphy Chief Operating Officer 40 0 X 167497 0 19049 Joseph Sassano Chief Information Officer 40 0 X 117578 0 16544 Gerald Anastasio Director of Human Resources 40 0 X 113831 0 16396 Christy Leo Communications Director 40 0 X 104810 0 15908 903618 0 108731 6 0 1 0 Towers Watson Pennsylvania Inc 1500 Market Street Centre Square East Philadelphia PA 19102 Actuarial Services 432641 Buchanan Ingersoll & Rooney One Oxford Centre 20th Floor 301 Grant Street Pittsburgh PA 15219 Legal Services 246397 Kirschner & Gartrell PC 4910 Massachusetts Ave NW Suite 215 Washington DC 20016 Legal services 201901 Ballard Spahr LLC 1735 Market Street Suite 5100 Philadelphia PA 19103 Actuarial services 119074 4 0 0 0 0 0 0 0 0 Employer Contributions 524292 883117167 883117167 0 0 Participant Contributions 524292 93963498 93963498 0 0 1355793 1355793 0 0 978436458 1130849 0 0 1130849 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 356661079 0 356937250 0 -276171 0 -276171 0 0 -276171 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 979291136 978436458 0 854678 0 0 0 926603220 278875 0 3272731 0 967949 294983 0 397861 64770 0 0 0 516196 0 671909 154435 0 340682 53765 0 0 0 0 1437589 179899 Retention Expense (Administrative Fee) 28053442 Mental Health/ Substance Abuse (Admin Fee) 2674635 Dues, Subscriptions and Licenses 620070 Disease Management 1325280 8330 967916621 0 0 0 0 0 103602334 142812779 0 0 72751493 74654989 0 0 0 0 0 0 0 0 425317 425319 26466148 21372708 4301636 5093440 212328783 178296431 0 0 0 0 0 0 0 0 393409563 401282958 37106146 34540052 0 0 0 0 0 0 0 0 0 0 0 0 0 0 74973746 72701523 112079892 107241575 X 0 0 0 0 281329671 294041383 281329671 294041383 393409563 401282958 11374515 1337197 0 0 0 0 X 0 1 X 1 0 0 0 0 0 0 0 0 0 364019 361208 2811 0 563504 561072 2432 0 25538625 20450428 5088197 5093440 0 Estimated Health Claims Incurred but not Reported 72701523 72701523 980628333 1337197 0 0 0 1337197 979291136 0 0 0 979291136 967916621 0 0 0 0 0 967916621 0 0 0 967916621 X 1 1 X X X X 0 0 0 Kathryn Farley Exec Director/CEO 228641 0 0 0 33474 0 12938 0 13226 0 288279 0 0 0 Robert Bickford CFO 136507 0 0 0 1280 0 7006 0 13226 0 158019 0 0 0 Nancy Murphy Chief Operating Officer 149087 0 0 0 18410 0 8454 0 13226 0 189177 0 0 Schedule J, Part I, Line 1a Schedule J, Part 1, Line 1a- Gross-up for Kathryn Farley in the amount of $6,799 Form 990, Part VI, Section B, Line 11b Form 990 is reviewed by the CFO and an outside accounting firm before being files the IRS. Form 990, Part VI, Section B, Line 12c The Conflict of Interest Policy is monitored and enforced as an integral part of the PEBTF Corporate Compliance Program. As such, the Corporate Compliance Officer in conjunction with the Corporate Compliance Committee, has the primary responsibility for the monitoring and enforcement of this policy. In addition, on an annual basis, the Human Resources Department requires each employee to sign a Conflict of Interest Statement which provides documentation of any actual or perceived conflict as well as reiterating the PEBTF's Policy regarding Conflict of Interest. Form 990, Part VI, Section B, Line 15 The process of determining compensation of the CEO is a process including the Compensation Committee of the Board of Directors, the Chair of the Finance Committee and the Chairman of the Board. (1) Independent Salary Survey Information is provided to the Compensation Committee by the Director of Human Resources. (2) A formal review of the CEO is performed by the Chairman of the Board comparing performance expectations to the actual performance for the year. (3) A performance increase is recommended by the Compensation Committee for an appropriate increase taking the Salary Survey information and performance into account. (4) In the event that the CEO's salary falls significantly outside the Independent Salary Survey range, either on the high or low side, additional information, such as alternative Salary Surveys or additional clarifying information is sought prior to the development of the increase amount. The process of determining compensation for the other officers and key employees of the organization is as follows: (1) Independent Salary Survey information is provided to the CEO by the Director of Human Resources. (2) A formal review of the key officer or key employee is performed by the CEO comparing performance expectation to actual performance for the year. (3) A performance increase in recommended by the CEO for an appropriate increase taking the Salary Survey information and performance into account. (4) In the event that the key officer of key employee's salary falls significantly outside of the Independent Salary Survey range, either on the high or low side, additional information, such as alternative Salary Surveys, comparative job responsibilities or additional clarifying information is sought prior to the development of the increase amount. Form 990, Part VI, Section C, Line 19 PEBTF's governing documents, conflict of interest policy and Financial Statements are not generally made available to the public. However, if there is a written request for the above information, the request is reviewed by the CEO with assistance from Corporate Counsel and a determination is made and rendered in writing to the requester. Additional time was necessary to gather the information required to file a complete and accurate return.