2012-03-15T14:47:24-07:00 2011-06-30 990 2010-07-01 521588740 PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND PENN 7175614750 150 SOUTH 43RD STREET SUITE 1 HARRISBURG PA 171115700 Robert Bickford 7175657318 2012-03-15 2010 2016-02-24 21:20:13Z Kathryn Farley 150 S 43rd Street Suite 1 Harrisburg PA 171115700 835518464 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 as well as other participants. 18 18 152 0 0 0 0 0 944563710 815142623 289428 588913 0 0 944853138 815731536 0 0 785638028 833508987 4796085 4694140 0 0 0 43381508 42073179 833815621 880276306 111037517 -64544770 491048667 430262647 81377145 84173367 409671522 346089280 Trust for the provision of medical, surgical, hospital and supplemental benefits to employees of the Commonwealth of Pennsylvania as well as other participants. 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 79,000 contracts or 187,000 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 0 1 399 0 1 152 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 Lorraine Barringer 7175614750 150 S 43rd Street Suite 1 Harrisburg PA 171115700 David Fillman 0 X 0 0 0 Richard Caponi 0 X 0 0 0 Michael Fox 0 X 0 0 0 Neal Bisno 0 X 0 0 0 Marc Kornfeld 0 X 0 0 0 Kathy Jellison 0 X 0 0 0 Wendell Young IV 0 X 0 0 0 Dominic Sgro 0 X 0 0 0 William Einhorn 0 X 0 0 0 Kelly Powell Logan 0 X 0 0 0 James A Honchar 0 X 0 0 0 Matt Waneck 0 X 0 0 0 David Donley 0 X 0 0 0 Charlene Couch 0 X 0 0 0 Ann Spishock 0 X 0 0 0 Jay Gasdaska 0 X 0 0 0 Charles Zogby 0 X 0 0 0 Todd Shamash 0 X 0 0 0 Kathryn Farley 40 X 241349 0 22617 Robert Bickford 40 X 137438 0 17880 Nancy Murphy 40 X 156296 0 18639 Joseph Sassano 40 X 123712 0 17163 Philip Witters 40 X 113370 0 16310 Gerald Anastasio 40 X 105370 0 16269 877535 0 108878 6 0 1 0 Vynamic 1650 Market St 36th Floor Philadelphia PA 19103 Consulting services 980411 Ballard Spahr Andrews & Ingersoll 1735 Market St 51st Floor Philadelphia PA 191037599 Legal services 622560 Kirschner & Gartrell PC 4910 Massachusetts Ave NW Suite 215 Washington DC 20016 Legal services 537994 Ingenix Health Intelligence PO Box 88050 Chicago IL 606801050 Consulting services 385700 Aon Consulting 555 East Lancaster Avenue Suite 300 PO Box 7300 Radnor PA 190877300 Actuarial services 359678 6 0 Employer contributions 524292 725261508 725261508 0 0 Participants contributions 524292 88775510 88775510 0 0 1105605 1105605 0 0 815142623 616339 0 0 616339 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19759502 0 19786928 0 -27426 0 -27426 0 0 -27426 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 815731536 815142623 0 588913 0 0 0 833508987 293546 0 3131093 0 991883 277618 0 474782 34475 0 0 0 535584 0 762251 147598 0 306647 28658 0 0 0 0 322743 113955 Retension expense (administration fees) 27698213 Mental health/substance abuse(admin fee) 2754215 Disease management 8791513 Dues, subscriptions & licenses 89691 12854 880276306 0 0 0 0 0 175913313 258197388 0 0 260637947 84937224 0 0 0 0 0 0 0 0 371029 390990 17336473 14903865 587894 2432608 53538484 84304437 0 0 0 0 0 0 0 0 491048667 430262647 27007884 18673385 0 0 0 0 0 0 0 0 0 0 0 0 0 0 54369261 65499982 81377145 84173367 X 0 0 0 0 409671522 346089280 409671522 346089280 491048667 430262647 X -64544770 962528 X 0 1 1 X 0 0 0 0 0 0 0 0 0 358394 342368 16026 0 563504 551697 11807 0 16414575 14009800 2404775 2432608 0 Estimated health claims incurred but not reported 65499982 65499982 815731536 880276306 -64544770 962528 0 0 0 0 962528 -63582242 816694064 962528 0 0 0 962528 815731536 0 0 0 815731536 880276306 0 0 0 0 0 880276306 0 0 0 880276306 X 1 1 X X X X 0 0 0 Kathryn Farley 211672 0 0 0 29677 0 11697 0 13785 0 266831 0 0 0 Nancy Murphy 147806 0 0 0 8489 0 7719 0 13785 0 177799 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Gross up for CEO Kathryn Farley in the amount of $5,448. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a Form 990 is reviewed by the CFO and an outside accounting firm before being filed with the IRS. F990_P06_S0B_L12c 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. F990_P06_S0B_L15 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 expectation to 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 of 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 is 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 or 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. F990_P06_S0C_L19 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. F990_P11_S00_L05 Form 990, Part XI, Line 5 Net unrealized gain.