2024-11-05T14:15:15-06:00 2024-06-30 201317788 BOWERS & COMPANY CPAS PLLC 1120 COMMERCE PARK DRIVE EAST WATERTOWN NY 13601 990 2023-07-01 222329543 JEFF-LEWIS ET AL SCH EMP HC PLAN JEFF 3156862615 PO BOX 456 CLAYTON NY 13624 TODD GREEN PLAN CHAIRPERSON 3156862615 2024-11-05 1 0 ELIZABETH BUSH P01264627 3157887690 2024-11-05 2023 2024-10-15 13:58:12Z TODD GREEN PO BOX 456 CLAYTON NY 13624 85865173 0 X N/A X 1979 NY PROVIDES HEALTH CARE BENEFITS FOR VARIOUS SCHOOL DISTRICTS IN JEFF-LEWIS COUNTIES. 20 20 0 0 0 0 0 0 82059049 82351732 2113603 2872893 990501 640548 85163153 85865173 0 0 78139515 94754915 0 0 0 0 0 3692315 3584232 81831830 98339147 3331323 -12473974 61086773 51319887 15262299 17817591 45824474 33502296 PROVIDES HEALTH CARE BENEFITS FOR VARIOUS SCHOOL DISTRICTS IN JEFF-LEWIS COUNTIES. 0 0 97949544 82992280 THE JEFFERSON-LEWIS ET.AL. SCHOOL EMPLOYEES' HEALTHCARE PLAN ("THE PLAN") WAS ORGANIZED IN 1979. THE PURPOSE OF THE PLAN IS TO PROVIDE HEALTH CARE INSURANCE FOR EMPLOYEES OF THE VARIOUS SCHOOL DISTRICTS IN JEFFERSON AND LEWIS COUNTIES, WHICH ARE MEMBERS OF THE PLAN. THE PLAN'S OBJECTIVES ARE TO DEVELOP AND ADMINISTER A PROGRAM OF EMPLOYEE HEALTH CARE, IN ORDER TO OBTAIN LOWER COVERAGE COST AND FURTHERMORE DEVELOP A COMPREHENSIVE LOSS CONTROL PROGRAM. 97949544 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 0 0 0 0 0 0 0 0 0 0 0 0 X 20 20 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X BRENDAN HIGGINS 3156862615 PO BOX 456 CLAYTON NY 13624 X NICOLE PARLIAMENT DESIGNEE 0.00 X 0 0 0 COLLEEN BELLINGER DESIGNEE 0.00 X 0 0 0 ANGELA PICUNAS DESIGNEE 0.00 X 0 0 0 BRIANNE KIRCHOFF DESIGNEE 0.00 X 0 0 0 DEBORAH DOMAGALA DESIGNEE 0.00 X 0 0 0 SCOTT LUTHER DESIGNEE 0.00 X 0 0 0 CHRISTINE WHEELER DESIGNEE 0.00 X 0 0 0 STEPHANIE WHEELER DESIGNEE 0.00 X 0 0 0 SANDRA RIVERS DESIGNEE 0.00 X 0 0 0 AUDREY STEVENSON DESIGNEE 0.00 X 0 0 0 TRACY STROCK DESIGNEE 0.00 X 0 0 0 SID POND DESIGNEE 0.00 X 0 0 0 JUDITH CURTIS ENROLLEE 0.00 X 0 0 0 MICHAEL POWERS ENROLLEE 0.00 X 0 0 0 MICHAEL MONTIGELLI ENROLLEE 0.00 X 0 0 0 ARIANA MORRISON DESIGNEE 0.00 X 0 0 0 TODD GREEN PLAN CHAIRPERSON 1.00 X 0 0 0 LISA SMITH VICE CHAIR 1.00 X 0 0 0 MICHELE CARPENTER TREASURER 1.00 X 0 0 0 MICHELLE O'CONNOR SECRETARY 1.00 X 0 0 0 0 0 0 0 0 0 0 0 HEALTH CARE PREMIUMS 525100 82351732 82351732 82351732 2872893 2872893 PERFORMANCE GUARANTEE PAYMENT 525100 640548 640548 640548 85865173 82992280 0 2872893 94754915 94754915 1000 1000 48724 48724 9800 9800 770 770 83119 83119 TPA FEES 2589010 2589010 REINSURANCE PREMIUMS 526576 526576 PLAN MANAGER 182840 182840 CONSULTANT 63350 63350 79043 79043 98339147 97949544 389603 0 2117752 1057973 58392277 49707681 576744 554233 61086773 51319887 1371933 1510744 13890366 16306847 15262299 17817591 X 45824474 33502296 45824474 33502296 61086773 51319887 -12473974 151796 0 X X 0 1 X 1 0 0 CLAIMS INCURRED BUT NOT REPORTED 16306847 16306847 X 86016969 151796 151796 85865173 0 85865173 98339147 0 98339147 0 98339147 PART X, LINE 2: THE PLAN IS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(9). THE PLAN'S FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FOR THE TAX YEARS ENDED 2022, 2021, AND 2020 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. THE PLAN HAS DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS AND THAT THE ORGANIZATION SHOULD PREVAIL UPON EXAMINATION BY TAXING AUTHORITIES. FORM 990, PART VI, SECTION A, LINE 3 THE HEALTHCARE PLAN USES STRATEGIC INNOVATIVE SOLUTIONS LLC TO PERFORM THE DAILY PLAN DUTIES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE RETURN WAS SENT TO THE PLAN MANAGER AND THE BOARD CHAIR FOR REVIEW AND APPROVAL PRIOR TO E-FILING. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS ARE REQUIRED TO ANNUALLY SIGN A STATEMENT THAT THEY HAVE A COPY OF THE POLICY, THAT THEY HAVE AGREED TO COMPLY WITH THE POLICY AND THAT THEY HAVE DISCLOSED ANY ACTIVITIES THAT MAY BE CONSIDERED A CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST BY MEMBERS. FORM 990, PART XII, LINE 2C FINANCE/AUDIT COMMITTEE OVERSEES AND APPROVES INDEPENDENT AUDIT.