2017-11-02T10:46:45-07:00 2016-12-31 990 2016-01-01 462975745 Reformed Benefits Association REFO 6162240716 1700 28th Street SE Grand Rapids MI 495081407 John Bolt Board Treasurer 6162240767 2017-11-02 12.239.150.194 2016 2021-01-29 14:40:06Z John Bolt 1700 28th Street SE Grand Rapids MI 495081407 17034094 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 17900978 16980293 12092 52803 0 0 17913070 17033096 0 0 12015818 10920063 380694 334219 0 0 0 5490329 5352608 17886841 16606890 26229 426206 3861354 4099341 1779510 1575531 2081844 2523810 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 15950670 0 17033096 Management and Administration services of health and welfare benefit plans for employees of its members and other eligible participating organizations. 0 0 0 15950670 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 1 0 1 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 X Robert Nykamp Board Member, President 0 0 X X 0 0 0 John Terpstra Board Member, Vice President 0 0 X X 0 0 0 Kenneth Wigboldy Board Member 0 0 X 0 0 0 Timothy Zeutenhorst Board Member 0 0 X 0 0 0 Denise Ratcliffe Board Member -outgoing 0 0 X 0 0 0 Lloyd Bierma Board Member 0 0 X 0 0 0 Nancy DeGood Board Member -Incoming 0 0 X 0 0 0 John Bolt Board Treasurer 6 34 X X 0 159387 40659 Kelly Oliveira Board Secretary 4 36 X X 0 92018 37455 Michelle DeBie Managing Director 14 26 X 0 123921 28953 0 375326 107067 0 0 1 0 United Health Care 22703 Network Pl Chicago IL 606731227 Health Plan administration 1754245 Blue Cross Blue Shield of Michigan PO Box 4407 Detroit MI 48277 Group Insurance premiums 1328340 Aetna PO Box 21673 Chicago IL 606731216 Group Insurance Premiums 1137003 Reliance Standard Life Insurance PO Box 3124 Southeastern PA 193983124 Group Insurance Premiums 631933 Blue Care Network PO Box 33608 Detroit MI 482325608 Group Insurance Premiums 115330 5 0 Participant Premiums 525100 16980293 16980293 0 0 0 0 0 0 16980293 52801 52801 0 0 0 0 0 0 0 0 0 0 0 0 1000 0 998 0 2 0 2 2 0 0 0 17033096 17033096 0 0 0 0 0 0 0 0 10920063 10920063 91142 0 91142 0 0 0 0 177216 0 177216 0 15044 0 15044 0 26694 0 26694 0 24123 0 24123 0 603602 603602 0 0 2116 0 2116 0 147958 0 147958 0 0 0 0 0 0 0 4057 0 4057 0 51030 51030 0 0 0 0 0 0 96823 0 96823 0 16733 0 16733 0 0 0 0 0 36194 0 36194 0 224 0 224 0 0 0 0 0 3154 0 3154 0 0 0 0 0 0 0 0 0 0 0 0 0 4341785 4327043 14742 0 ACA Transitional Reinsurance Program and PCORI tax 48932 48932 0 0 0 0 0 0 16606890 15950670 656220 0 2482144 2573187 0 0 0 0 128736 112253 0 0 0 0 0 0 0 0 262254 366732 0 988220 1047169 0 0 0 0 0 0 0 0 3861354 4099341 1748486 1558519 0 0 31024 17012 0 0 0 0 0 0 0 0 0 0 0 1779510 1575531 X 2081844 2523810 0 0 0 0 2081844 2523810 3861354 4099341 426206 15760 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 17048856 15760 0 0 0 15760 17033096 0 0 0 17033096 16606890 0 0 0 0 0 16606890 0 0 0 16606890 0 0 0 0 0 0 0 0 0 John Bolt Board Treasurer 0 158270 0 127 0 990 0 16351 0 24308 0 200046 0 0 Michelle DeBie Managing Director 0 123027 0 249 0 645 0 12567 0 16386 0 152874 0 0 Form 990, Part VI, Section A, Line 6 Organization members: The RBA has two initial members, the Christian Reformed Church in North America Board of Trustees, (or CRCNA BOT) 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 Robert Nykamp: 778 Concord Dr, Holland MI 49423, John Terpstra: 3221 W Prospect Rd, Fort Collins, CI 80526, Kenneth Wigboldy: 2173 Hall Circle, Livermore, CA 94550, Timothy Zeutenhorst: 914 7th St SW, Orange City, IA 51041, Denise Ratcliffe: 75 Summer Hill Rd, Wayne, NJ 07470, Nancy DeGood: 3548 W Field Ct, Hamilton MI 49419-9668, Lloyd Bierma: 492 Orchard Hill Rd, Holland, MI 49424, Kelly Oliveria: 4500 60th St SE Grand Rapids, MI 49512, 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 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 36027 Allocation Christian Reformed Church in North America o 321165 Actual Christian Reformed Church in North America p 168324 Allocation Reformed Church in America Board of Benefit Services n 167 Allocation Reformed Church in America Board of Benefit Services o 13054 Actual Reformed Church in America Board of Benefit Services p 237 Allocation Extension was requested to allow time for completion of the independent audit.