2025-02-20T11:03:15-07:00 2024-06-30 990 2023-07-01 521588740 PENNSYLVANIA EMPLOYEES BENEFIT TRUST FUND PENN 7175657318 150 South 43rd Street Harrisburg PA 17111 John Cromer Accounting Manager 7175657318 2025-02-20 1 2023 2025-03-06 01:10:19Z Don Clair 150 South 43rd Street Harrisburg PA 17111 1572818475 0 X www.PEBTF.org X 1988 PA Trust for the provision of employee benefits to employees of the Commonwealth of Pennsylvania. 18 18 117 18 0 0 0 0 1197422992 1314022327 6547190 34695852 0 0 1203970182 1348718179 0 0 1098701535 1134318542 6003622 6698728 0 0 0 27179283 30673140 1131884440 1171690410 72085742 177027769 1000446816 1187630384 121547406 121037571 878899410 1066592813 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 To provide medical, surgical, hospital, and supplemental benefits to employees of the Commonwealth of Pennsylvania as well as other participants. Benefits provided to approximately 67,100 contracts, or 152,000 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 6 0 1 117 1 0 0 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 Don Clair 7175657215 150 South 43rd Street Harrisburg PA 17111 Kathryn Farley Former Executive Director / CEO 40 X 308392 0 31719 Lori Donovan COO 40 X 246966 0 37983 Sharon Young CFO 40 X 189025 0 24972 Jim Cibak Chief Information Officer 40 X 182897 0 25955 John-Marc Blanche Network Manager 40 X 148821 0 23911 Amy Spease Director of Support Services / Training 40 X 138410 0 23880 Christy Leo Director of Communications 40 X 132195 0 23196 John Cromer Accounting Manager 40 X 120366 0 22127 Linda Tezak Data Center Manager 40 X 119147 0 22561 Neil Weaver Chairman 0.25 X X 0 0 0 Michael Sukal Secretary 0.25 X X 0 0 0 Stephen Catanese Board Member 0.25 X 0 0 0 Valarie Arkoosh Board Member 0.25 X 0 0 0 William Einhorn Board Member 0.25 X 0 0 0 Natalie Krug Board Member 0.25 X 0 0 0 Kerri Gallagher Board Member 0.25 X 0 0 0 Tara Long Board Member 0.25 X 0 0 0 Zollie J Rayner Jr Board Member 0.25 X 0 0 0 H Ben Lukens Board Member 0.25 X 0 0 0 Tom Tosti Board Member 0.25 X 0 0 0 Uri Monson Board Member 0.25 X 0 0 0 Adam K Weber Board Member 0.25 X 0 0 0 Tracy Sullivan Board Member 0.25 X 0 0 0 Matt Yarnell Board Member 0.25 X 0 0 0 Erika Swaney Board Member 0.25 X 0 0 0 Wendell Young IV Board Member 0.25 X 0 0 0 Jason Swarthout Board Member 0.25 X 0 0 0 Dave Henderson Board Member 0.25 0 X X 0 0 0 Don Clair Executive Director/CEO 40 X 0 0 0 1586219 0 236304 20 0 1 0 Standish Mellon Asset Management 500 Grant Street Pittsburgh PA 15258 Investment Management 715389 Willis Towers Watson 1735 Market Street Philadelphia PA 19103 Actuarial Services 603277 Kennedy Printing Company Inc 5534 Baltimore Avenue Philadelphia PA 19143 Printing and Mailing 360382 HUB International 1007 Mumma Road Suite 200 Wormleysburg PA 19103 Insurance Services 338911 Ballard Spahr LLP 1735 Market Street 51st Floor Philadelphia PA 19103 Legal Services 260347 10 0 Employer contributions 524292 1155971741 1155971741 0 0 Participant contributions 524292 156889897 156889897 0 0 1160689 1160689 0 0 1314022327 39586490 39586490 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 219209658 0 224100296 0 -4890638 0 -4890638 -4890638 0 0 0 1348718179 1348718179 0 0 0 0 0 1134318542 665159 0 4330425 239898 1067865 395381 0 380064 91165 0 0 894709 966531 0 419975 886230 0 179637 25409 0 0 0 0 88774 213566 Retention Expense Admin 20291731 Mental Health/Substance Abuse 5687732 Dues Subscriptions, Licenses 485094 Disease Management 26756 35767 1171690410 0 0 0 0 0 431589065 491674888 0 0 144070085 140940128 0 0 0 0 0 0 0 0 399996 1676357 39147475 38947594 260900 199881 423930064 553006919 0 0 0 0 196706 0 0 132211 1000446816 1187630384 37028406 41337571 0 0 0 0 0 0 0 0 0 0 0 0 0 0 84519000 79700000 121547406 121037571 X 0 0 0 0 878899410 1066592813 878899410 1066592813 1000446816 1187630384 X 177027769 10142567 0 0 0 523067 X 0 1 X 1 0 0 0 0 0 0 0 0 422370 0 419326 3044 571303 0 568926 2377 38153802 0 37959342 194460 199881 0 Estimated health claims incurred but not reported 79700000 79700000 1358860746 10142567 0 0 0 10142567 1348718179 0 0 0 1348718179 1171690410 0 0 0 0 0 1171690410 0 0 0 1171690410 X 1 1 X X X 0 0 0 Kathryn Farley Former Executive Director / CEO 295785 0 0 0 12607 0 17081 0 22617 0 348090 0 0 0 Lori Donovan COO 246275 0 0 0 690 0 23345 0 21372 0 291682 0 0 0 Sharon Young CFO 188335 0 0 0 690 0 10334 0 20817 0 220176 0 0 0 Jim Cibak Chief Information Officer 181220 0 0 0 1677 0 11317 0 20553 0 214767 0 0 0 John-Marc Blanche Network Manager 148119 0 0 0 702 0 9273 0 18640 0 176734 0 0 0 Amy Spease Director of Support Services / Training 137776 0 0 0 635 0 9242 0 14638 0 162291 0 0 0 Christy Leo Director of Communications 130473 0 0 0 1723 0 8558 0 18147 0 158901 0 0 0 Schedule J, Part I, Line 1a Gross-up for Kathryn Farley for the current year totaled $2,428. Form 990, Part VI, Section B, Line 11b The form 990 is reviewed by the CFO and an outside accounting firm before being filed with 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 Pennsylvania Employee Benefit Trust Fund (PEBTF) corporate compliance program. As such, the corporate compliance office, in conjunction with the corporate compliance committee has the primary responsibility for 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. Any noted conflicts of interest would require the employee to recuse themselves from any dealings or decisions related to the party with which they have an actual or perceived conflict. Form 990, Part VI, Section B, Line 15 The process of determining compensation of the CEO includes the Compensation Committee of the Board of Trustees, the Chair of the Finance Committee, and the Chair 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 Chair of the Board comparing performance expectations to the actual performance for the year. (3) A performance increase is recommended by the Compensation Committee after taking the salary survey range and performance information into account. (4) In the event the CEO's salary falls significantly outside the independent salary survey range, either on the high or low side, additional information is sought prior to development of an increase amount. The process of determining compensation for the other officers and key employees is led by the CEO and follows the steps noted above. Salary data obtained from executive search firms is used for comparability while the final compensation amounts require approval from the Board of Trustees. 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 requestor Form 990, Part XI, Line 9 Decrease in benefit obligations of $523,067.