2019-11-14T11:29:51-07:00 2018-12-31 990 2018-01-01 462975745 Reformed Benefits Association REFO 6162240716 1700 28th Street SE Grand Rapids MI 495081407 John Bolt Board Treasurer 6162240767 2019-11-14 12.239.150.194 2018 2020-03-31 21:24:44Z John Bolt 1700 28th Street SE Grand Rapids MI 495081407 17660078 0 X www.reformedbenefits.org X 2013 MI The Board of Trustees of the Christian Reformed Church in North America (CRCNA BOT) and the Reformed Church in America Board of Benefits Services (RCA BOBS) established the Reformed Benefits Association (RBA) for the provision, management and administration of health and welfare benefit plans for ministers, lay employees and retirees of the denominations, their agencies and participating churches and other assemblies on a joint basis. Further, the RBA was established to develop a spirit of Christian fellowship and cooperative mission among the denominations to promote, through cooperative effort, the spiritual, moral, social and civic welfare of the Christian community. As a result, the CRCNA BOT and the RCA BOBS, as members of the RBA, delegate the authority of the RBA Board of Trustees to conduct these activities and identify additional services which can be performed by the RBA on a joint basis on behalf of its members. 8 6 0 0 0 0 0 0 16968182 17179493 49596 49154 0 0 17017778 17228647 0 0 11568611 10822177 316095 330278 0 0 0 5648067 5850827 17532773 17003282 -514995 225365 3945041 4146652 1942121 1950519 2002920 2196133 X The RBA has been established for the provision, management and administration of health and welfare benefit plans for member denominations, their ministers, lay employees, retirees, agencies and participating churches and other assemblies on a joint basis. 0 0 16381139 0 17228647 Management and Administration services of health and welfare benefit plans for employees of its members and other eligible participating organizations. 0 0 0 16381139 1 0 0 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 0 1 1 1 0 0 1 1 1 1 1 1 1 0 X John Bolt 6162245889 1700 28th Street SE Grand Rapids MI 495081407 X John Terpstra Board Member, President 0 0 X 0 0 0 Nancy DeGood Board Member -Vice President 0 0 X 0 0 0 Lloyd Bierma Board Member 0 0 X 0 0 0 Kenneth Wigboldy Board Member 0 0 X 0 0 0 James Kuplic Board Member 0 0 X 0 0 0 Dana Chapman Board Member -incoming 0 0 X 0 0 0 Timothy Zeutenhorst Board Member -outgoing 0 0 X 0 0 0 John Bolt Board Treasurer 4 36 X X 0 163484 43963 Kelly Oliveira Board Secretary 4 36 X X 0 98589 37364 Michelle DeBie Managing Director 14 26 X 0 126619 30977 0 388692 112304 0 0 1 0 United Health Care 22703 Network Pl Chicago IL 606731227 Health Plan administration 1638898 Aetna PO Box 21673 Chicago IL 606731216 Group Insurance Premiums 1118957 Blue Cross Blue Shield of Michigan PO Box 4407 Detroit MI 48277 Group Insurance premiums 980459 Delta Dental Plan of Michigan 4100 Okemos Rd Okemos MI 48864 Group Insurance Premiums 796995 Reliance Standard Life Insurance PO Box 3124 Southeastern PA 193983124 Group Insurance Premiums 761806 5 0 Participant Premiums 525100 17179493 17179493 0 0 0 0 0 0 17179493 50155 50155 0 0 0 0 0 0 0 0 0 0 0 0 430430 0 431431 0 -1001 0 -1001 -1001 0 0 0 17228647 17228647 0 0 0 0 0 0 0 0 10822177 10822177 84365 0 84365 0 0 0 0 0 168386 0 168386 0 15852 0 15852 0 43660 0 43660 0 18015 18015 0 588069 588069 0 0 110 0 110 0 138248 0 138248 0 0 0 0 0 0 0 4402 0 4402 0 45509 45509 0 0 0 0 0 83412 0 83412 0 20475 0 20475 0 0 0 0 0 26784 0 26784 0 2600 0 2600 0 0 0 0 0 2356 0 2356 0 0 0 0 0 0 0 0 0 0 0 0 0 4930413 4916935 13478 PCORI Fees (Patient Centered Outcomes Research Institute) 8449 8449 0 0 0 0 0 0 17003282 16381139 622143 0 2459186 2677493 0 0 0 0 198210 197015 0 0 0 0 0 0 0 0 196779 175335 1090866 1096809 0 0 0 0 0 0 0 0 3945041 4146652 1919842 1920753 0 0 22279 29766 0 0 0 0 0 0 0 0 0 0 0 1942121 1950519 X 2002920 2196133 0 0 0 0 2002920 2196133 3945041 4146652 225365 -32152 0 0 0 0 X 0 1 X 0 0 X X X 2 Christian Reformed Church in North America 382051351 1 1 0 0 Reformed Church in America Board of Benefits Services 135562285 1 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 17196495 -32152 0 0 0 -32152 17228647 0 0 0 17228647 17003282 0 0 0 0 0 17003282 0 0 0 17003282 0 0 0 0 0 0 0 0 0 John Bolt Board Treasurer 0 161269 0 127 0 2088 0 16708 0 16923 0 197115 0 0 Michelle DeBie Managing Director 0 125839 0 135 0 645 0 12842 0 8448 0 147909 0 0 Schedule J, Part I, Line 3 Part I 3: Compensation review and approval:The Benefits Director, is currently secunded under the CRCNA payroll with costs allocated to the RBA. The current CRCNA pay scale and compensation evaluations are applied to any RBA employee. All CRCNA compensated employee positions, including any officers or director positions are evaluated by the Human Resource Committee (HRC) and an outside group to determine position grades or levels. Each grade is then assigned a Pay Scale based on Internal, Individual, and External Equity. These Pay Grades and Pay Scales are annually reviewed an updated by the HRC. Form 990, Part I, Line 1 The Board of Trustees of the Christian Reformed Church in North America (CRCNA BOT) and the Reformed Church in America Board of Benefits Services (RCA BOBS) established the Reformed Benefits Association (RBA) for the provision, management and administration of health and welfare benefit plans for ministers, lay employees and retirees of the denominations, their agencies and participating churches and other assemblies on a joint basis. Further, the RBA was established to develop a spirit of Christian fellowship and cooperative mission among the denominations to promote, through cooperative effort, the spiritual, moral, social and civic welfare of the Christian community. As a result, the CRCNA BOT and the RCA BOBS, as members of the RBA, delegate the authority of the RBA Board of Trustees to conduct these activities and identify additional services which can be performed by the RBA on a joint basis on behalf of its members. Form 990, Part III, Line 1 The RBA has been established for the provision, management and administration of health and welfare benefit plans for member denominations, their ministers, lay employees, retirees, agencies and participating churches and other assemblies on a joint basis. Form 990, Part III, Line 4a Management and Administration services of health and welfare benefit plans for employees of its members and other eligible participating organizations. Form 990, Part VI, Section A, Line 6 Organization members: The RBA has two initial members, The Christian Reformed Church in North America Council of Delegates (CRCNA COD) (formerly the Christian Reformed Church in North America Board of Trustees), and the Reformed Church in America Board of Benefit Services (RCA BOBS). Additional members can be admitted by the RBA Board of Trustees with the provision that they do not jeopardize the tax-exempt status of the RBA under Section 501(c)3 of the code and that admittance of the new member does not cause any benefit plans sponsored by the RBA to cease constituting a single employer plan within the meaning of CPPEPA. Form 990, Part VI, Section A, Line 7a Member authorization to appoint Trustees: Per amended Bylaws (2015) of the RBA, the RBA Board of Trustees is comprised of 8 voting trustees, 6 Regular Trustees and 2 Staff Trustees. Each member organization appoints 3 Regular Trustees, and 1 Staff Trustee. The Staff Trustee will be a paid denomination executive whom is appointed by the originating members. Trustee vacancies will be filled by the original appointing member of the trustee position that is vacant. Form 990, Part VI, Section A, Line 9 John Terpstra: 3221 W Prospect Rd, Fort Collins, CO 80526, Kenneth Wigboldy: 2173 Hall Circle, Livermore, CA 94550, Nancy DeGood: 3548 W Field Ct, Hamilton MI 49419-9668, Lloyd Bierma: 492 Orchard Hill Rd, Holland, MI 49424, James Kuplic: 511 Old Country Road PP, Sheboygan Falls, WI 53085-1869, Dana Chapman: 1617 Hunters Field Ln, Marion, IA 52302-4707, Kelly Oliveria: 4500 60th St SE Grand Rapids, MI 49512, Timothy Zeutenhorst: 914 7th St SW, Orange City, IA 51041 Form 990, Part VI, Section B, Line 11b Review of the 990 form: The 990 form is completed by the Finance Manager for the RBA and submitted to the Board Treasurer for review prior to submitting to the IRS Form 990, Part VI, Section B, Line 12c Conflict of Interest policy: All Board members are required to sign the Conflict of Interest Policy. The policy is given out as a part of the annual August Board meeting. Existing board members are required to review and re-submit the form if any changes to their status occurred, new Board Members are required to submit the form at that time. Form 990, Part VI, Section B, Line 13 Whistleblower Policy: All RBA employee positions are paid as CRCNA employees. As such, all policies in place for CRCNA employees are also applied to RBA employees. The CRCNA has a public whistleblower policy available on their website, www.crcna.org Form 990, Part VI, Section B, Line 14 Document Retention and Destruction Policy: All financial services for the RBA are handled in the CRCNA financial services department. The CRCNA written document retention and destruction policy is applied to all services rendered for the RBA. Form 990, Part VI, Section B, Line 15 Compensation review and approval:The CRCNA Staff Board Member, and the Benefits Director, are currently secunded under the CRCNA payroll with costs allocated to the RBA. The current CRCNA pay scale and compensation evaluations are applied to any RBA employee. All CRCNA compensated employee positions, including any officers or director positions are evaluated by the Human Resource Committee (HRC) and an outside group to determine position grades or levels. Each grade is then assigned a Pay Scale based on Internal, Individual, and External Equity. These Pay Grades and Pay Scales are annually reviewed an updated by the HRC. the RCA Staff Board Member is currently secunded under the RCA payroll with costs allocated to the RBA. RCA compensation practices are not known. Form 990, Part VI, Section C, Line 19 Availability of public documents: The RBA Govering Documents, Conflict of Interest Policy, and financial statements are available on request. Form 990, Part VII, Section A, Line 1a Related Organization compensation for Kelly Oliveira is estimated due to availability of W-2 information. The estimate is based on agreed on compensation reimbursements being 10% of salary and benefits. Christian Reformed Church in North America 1700 28th Street SE Grand Rapids MI 495081407 382051351 Religious MI 501(c)3 1 N/A 0 Reformed Church in America Board of Benefit Services 475 Riverside Dr Suite 1606 New York NY 10115 135562285 Religious NY 501(c)3 1 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Christian Reformed Church in North America n 26628 Allocation Christian Reformed Church in North America o 316683 Actual and Allocation Christian Reformed Church in North America p 242135 Allocation Reformed Church in America Board of Benefit Services n 156 Allocation Reformed Church in America Board of Benefit Services o 13595 Allocation Extension was requested to allow time for completion of the independent audit.