2023-09-13T19:26:24-05:00 2022-12-31 WITHUMSMITHBROWNPC 4600 EAST WEST HWY 900 BETHESDA MD 208143423 990 2022-01-01 521074154 SPECIAL AGENTS MUTUAL BENEFIT ASSOCIATION % PAMELA LYNCH SPEC 3019841440 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 KATHRYN DIEM TREASURER/DIRECTOR 3019844110 2023-09-02 true KATHRYN DIEM 999009999 RICHARD RUVELSON P00234075 3012726000 3 2022 2023-04-26 12:10:37Z KATHRYN DIEM 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 362527015 false X WWW.SAMBAPLANS.COM X 1976 DC TO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN FOR ITS MEMBERSHIP. 6 6 57 0 0 0 0 0 238313662 238573184 3506821 724912 0 0 241820483 239298096 220 6000 219887342 232881147 8011226 8144693 0 0 0 12184482 11807747 240083270 252839587 1737213 -13541491 232831711 214009029 69757128 60376768 163074583 153632261 TO SPONSOR AND ADMINISTER THE SAMBA BENEFIT PLAN ("THE PLAN") FOR ITS MEMBERSHIP IN ACCORDANCE WITH ERISA AND FEHBA. THE SAMBA BENEFIT PLAN INCLUDES HEALTH, LIFE, DISABILITY, ACCIDENT, DENTAL, VISION AND RELATED COVERAGES. false false SPONSORED HEALTH, GROUP TERM LIFE, DISABILITY, ACCIDENT, DENTAL AND VISION BENEFITS FOR APPROXIMATELY 101,009 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 23 0 true 57 true false false 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 PAMELA LYNCH 3019844109 11301 OLD GEORGETOWN ROAD ROCKVILLE MD 20852 X WALTER E WILSON EXECUTIVE DIRECTOR 40.0 0.0 X 583758 0 -99300 LAURENCE GROSS SENIOR PROGRAM ADMINISTRATOR 40.0 0.0 X 236156 0 33495 JERRY BROWN MANAGER, IT 40.0 0.0 X 195854 0 39806 WILLIAM MARTIN MANAGER, IT 40.0 0.0 X 205034 0 17649 SANG WOO Senior Computer Programer 40.0 0.0 X 170591 0 46490 PAMELA LYNCH CONTROLLER 40.0 0.0 X 240842 0 -46187 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 40.0 0.0 X 329089 0 -146077 VIEN LIM SENIOR NETWORK ADMINSTRATOR 40.0 0.0 X 156944 0 6946 WILLIAM P O'HANLON PRESIDENT/BOARD MEMBER 4.0 0.0 X X 46000 0 0 DAVID R LOESCH VICE PRESIDENT/BOARD MEMBER 1.0 0.0 X X 3000 0 0 KATHRYN DIEM TREASURER/BOARD MEMBER 1.0 0.0 X X 3000 0 0 JOSEPH R DAVIS BOARD MEMBER 1.0 0.0 X 3000 0 0 CHARLENE B THORNTON BOARD MEMBER 1.0 0.0 X 3000 0 0 ANGELA ZENTZ BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID ERMER SECRETARY 1.0 0.0 X 0 0 0 2176268 0 -147178 16 false true false CIGNA HEALTHCARE 1111 MARKET STREET CHATTANOOGA TN 37402 HEALTH NETWORK ADMIN 4289959 EXPRESS SCRIPTS HLD CO 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 PHARMACY BENEFIT MGR 1887191 CHANGE HEALTHCARE 3055 LEBANON PIKE SUITE 1000 NASHVILLE TN 37214 PRINTING & MAILING 658834 RAM TECHNOLOGIES INC 275 COMMERCE DRIVE SUITE 100 FORT WASHINGTON PA 19034 SOFTWARE MAINTENANCE 567153 MULTIPLAN INC PO BOX 29380 NEW YORK NY 10087 HEALTH NETWORK ADMIN 382288 17 0 PREMIUMS 525100 233401009 233401009 ADMINISTRATION FEES 525100 3974241 3974241 EXPERIENCE RATING ADJUSTMENT 525100 1179367 1179367 CARRIER INVESTMENT INCOME 525100 18567 18567 238573184 3081811 0 3081811 0 0 0 0 0 120872020 123228919 -2356899 -2356899 -2356899 0 0 0 0 0 0 0 0 0 0 239298096 238573184 0 724912 6000 0 0 232881147 1348717 0 4671945 878854 846711 398466 0 71676 234302 0 0 290863 7261661 0 1155026 1737793 0 184580 29185 0 0 0 0 269658 154500 MISCELLANEOUS 255737 TAXES - PROPERTY 76394 PCORI EXCISE TAX 73140 CLEARING HOUSE EXPENSE 13232 252839587 525 525 65012973 56417624 0 0 20244959 22340148 0 0 0 0 0 0 0 0 667240 1186904 13757205 12193179 1752887 1564026 143837323 130302519 0 0 0 0 0 0 1315804 2197283 232831711 214009029 2663099 2613447 0 0 0 0 0 0 0 0 0 0 0 0 0 0 67094029 57763321 69757128 60376768 X 0 0 0 0 163074583 153632261 163074583 153632261 232831711 214009029 X -13541491 -13762371 17861540 X X false true X true false 600000 600000 5757919 4955830 802089 6841042 6688168 152874 558244 549181 9063 1564026 0 SPECIAL RESERVE - OPM 27222610 RESERVE FOR UNPAID CLAIMS 25156840 ACCRUED PENSION LIABILITY 1402719 GROUP INSURANCE PREMIUM PAYABLE 3421835 PROVISION FOR POST RETIREMENT 559317 57763321 X 227308463 -13762371 1772738 -11989633 239298096 239298096 254612325 1772738 1772738 252839587 252839587 PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE: U.S. GAAP requires 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, 2022 and 2021 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. In addition, there have been no tax related interest or penalties for periods presented in these financial statements. PART XI, LINE 2D - OTHER REVENUES ON AUDITED F/S, NOT ON RETURN: INTERPLAN ALLOCATIONS $1,772,738 PART XII, LINE 2D - OTHER EXPENSES ON AUDITED F/S, NOT ON RETURN: INTERPLAN ALLOCATIONS $1,772,738 X X X false false false WALTER E WILSON EXECUTIVE DIRECTOR 448110 0 128396 0 7252 0 -108132 0 8832 0 484458 0 0 0 PAMELA CUMMINGS DEPUTY EXECUTIVE DIRECTOR 274089 0 55000 0 0 0 -162003 0 15926 0 183012 0 0 0 LAURENCE GROSS SENIOR PROGRAM ADMINISTRATOR 223656 0 12500 0 0 0 10369 0 23126 0 269651 0 0 0 VIEN LIM SENIOR NETWORK ADMINSTRATOR 149444 0 7500 0 0 0 -16180 0 23126 0 163890 0 0 0 PAMELA LYNCH CONTROLLER 222842 0 18000 0 0 0 -72163 0 25976 0 194655 0 0 0 WILLIAM MARTIN MANAGER, IT 187534 0 17500 0 0 0 -5477 0 23126 0 222683 0 0 0 JERRY BROWN MANAGER, IT 178354 0 17500 0 0 0 15180 0 24626 0 235660 0 0 0 SANG WOO Senior Computer Programer 165591 0 5000 0 0 0 30564 0 15926 0 217081 0 0 0 SCHEDULE J, PART II, COLUMN C RETIREMENT AND OTHER DEFERRED COMPENSATION THE INCREASE (DECREASE) IN THE TOTAL PRESENT VALUE OF THE BENEFIT COMES PRIMARILY FROM THE INCREASE (DECREASE) IN ACCRUALS DURING THE YEAR. ADDITIONALLY, THE DISCOUNT RATE USED AT THE END OF 2021 WAS 3.50%, WHILE THE DISCOUNT RATE USED AT THE END OF 2022 WAS 5.00%. THERE WAS NO EFFECT ON THE LIABILITIES FROM DISCOUNT RATE FLUCTUATION. THESE ARE ACTUARY CALCULATIONS AND THESE AMOUNTS DO NOT REPRESENT A CASH OUTLAY. 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 ADMITED 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 VI, 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 2022. FORM 990, PART VI, 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 its website for anyone to view, with the latest update as of October 22, 2012. FORM 990, PART XI, LINE 9: OTHER CHANGES TO NET ASSETS OR FUND BALANCE OF $17,861,539 CONSISTS OF THE FOLLOWING: INCREMENTAL EFFECT OF FASB ASC TOPIC 715 - POST RETIREMENT BENEFITS OF $806,472, CONTINGENCY RESERVE PAYMENTS - $7,727,447, SPECIAL RESERVE OF $9,327,620. FORM 990, PART VII, SECTION A, COLUMN F: ESTIMATED AMOUNT OF OTHER COMPENSATION THE INCREASE (DECREASE) IN THE TOTAL PRESENT VALUE OF THE BENEFIT COMES PRIMARILY FROM THE INCREASE (DECREASE) IN ACCRUALS DURING THE YEAR. ADDITIONALLY, THE DISCOUNT RATE USED AT THE END OF 2021 WAS 3.50%, WHILE THE DISCOUNT RATE USED AT THE END OF 2022 WAS 5.00%. THERE WAS NO EFFECT ON THE LIABILITIES FROM DISCOUNT RATE FLUCTUATION. THESE ARE ACTUARY CALCULATIONS AND THESE AMOUNTS DO NOT REPRESENT A CASH OUTLAY. FORM 990, PART XII, LINE 1: BASIS OF PRESENTATION THIS TAX RETURN COMBINES TWO PLANS OF THE ENTITY. THE FINANCIAL STATEMENTS OF THE BENEFIT PLAN ARE IN ACCORDANCE WITH GAAP. THE FINANCIAL STATEMENTS OF THE HEALTH PLAN ARE PREPARED PURSUANT TO THE U.S. OFFICE OF PERSONNEL MANAGEMENT'S (OPM) PRESCRIBED ACCOUNTING PRACTICES FOR FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM ("FEHBP") CARRIERS AND IS NOT INTENDED TO BE A COMPLETE PRESENTATION IN ACCORDANCE WITH GAAP. IN ACCORDANCE WITH OPM'S PRESCRIBED ACCOUNTING PRACTICES, EXPENSES ARE ONLY RECOGNIZED AND PAID BY THE HEALTH PLAN IF ALLOWED UNDER THE U.S. GOVERNMENT'S COST ACCOUNTING STANDARDS AND OTHER LIMITATIONS IMPOSED BY THE CONTRACT WITH OPM. IN THIS REGARD, SOME EXPENSES NOT ALLOWED BY THE HEALTH PLAN ARE CHARGED AS MISCELLANEOUS EXPENSES OF THE BENEFIT PLAN.