2025-11-17T10:20:11-06:00 2024-12-31 420714325 RSM US LLP 6 S Patterson Blvd Dayton OH 45402 990 2024-01-01 341331804 Trust Agreement for the Ohio Farmers Insurance Co Group Health Benefit Plan TRUS 3308870461 PO Box 5001 Westfield Center OH 44251 Jennifer Palmieri Chairman 3308870461 2025-11-14 1 1 Karen O Crim P00368385 9372980201 2025-11-14 2024 2025-03-06 01:10:19Z Jennifer Palmieri PO Box 5001 Westfield Center OH 44251 39666095 0 X www.westfieldinsurance.com X 1996 OH Provide health benefits including hospitalization, major medical, dental, prescription drug, and other health benefits to participants. 6 0 0 0 783968 781968 0 0 36052730 38321689 797614 783968 0 0 36850344 39105657 0 0 34427274 37531004 0 0 0 0 0 1906172 4038668 36333446 41569672 516898 -2464015 10628551 7936301 9171029 8466367 1457522 -530066 Provide health benefits including hospitalization, major medical, dental, prescription drug, and other health benefits to participants and their dependents. Also provides for employee assistance programs and retiree health and life plans. 0 0 Paid benefits (medical, dental, vision, prescription drug, life) claims for active employees, retirees, beneficiaries Payments to third party contractors for administration of benefits 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Ohio Farmers Insurance Company 3308878431 One Park Circle Westfield Center OH 44251 X Jennifer Palmieri Chairman 1.00 X 0 0 0 Joseph Kohmann Treasurer 1.00 X 0 0 0 Jodi Abbate BAC Member 1.00 X 0 0 0 Kathy Golovan BAC Member 1.00 X 0 0 0 Jeffrey Gillentine BAC Member 1.00 X 0 0 0 Krishna Patel BAC Member 1.00 X 0 0 0 0 0 0 0 0 0 0 United Healthcare Insurance Company PO Box 1459 Minneapolis MN 55440 Claims TPA 2001462 1 Employer Contributions 900099 26733930 26733930 Employee Contributions 900099 11332559 11332559 Reserve - unpaid claims 900099 255200 255200 38321689 669011 669011 675395 560438 114957 114957 114957 39105657 38321689 783968 0 37531004 Administrative Fees 1940423 UBI Tax 221354 1876891 41569672 7728710 288536 5867605 222121 175255 2677720 1604905 10628551 7936301 3818312 3873310 5352717 4593057 9171029 8466367 X 1457522 -530066 0 0 0 0 1457522 -530066 10628551 7936301 -2464015 -28033 504460 0 X 0 1 X 1 0 0 Reserve for retired life benefits 1737357 Incurred & unpaid benefit reserve 2855700 4593057 X Part X, Line 2: The Trust received an exemption letter from the Internal Revenue Service (IRS) dated February 4, 1980, stating that the Trust was tax-exempt under the provisions of Section 501(c)(9) of the IRC as a VEBA. Subsequent to the receipt of this letter, the Trust and the Plan were amended, and the Trust received letters from the IRS dated March 18, 1988, and January 14, 1999, stating that the exempt status of the Trust remains effective. The Plan and Trust are required to operate in conformity with the IRC to maintain the tax-exempt status of the Trust. The Plan administrator believes the Plan, as amended, is designed and being operated in compliance with the applicable requirements of the IRC and, therefore, believes the related Trust is tax exempt. As a result of the Plan's funding policy, from time to time, the Trust may be subject to income taxes. Net investment income earned on the Plan's assets held in the Trust is subject to unrelated business income taxes. Accounting principles generally accepted in the United States of America require Plan management to evaluate tax positions taken by the Plan and recognize a tax liability (or asset) if the Plan has taken an uncertain position that more likely than not would not be sustained upon examination by the federal or state taxing authorities. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Form 990, Part VI, Section B, line 11b Form 990 and supplemental forms and schedules are given to the governing body members for review and approval. Prior to filing, questions and comments from governing members are addressed and incorporated into the tax return filing as necessary. Form 990, Part VI, Section B, line 12c The organization prompty evaluates any identified exceptions of its conflict-of-interest policy. The policy is distributed annually to the trustees as an aid to enforcement. Form 990, Part VI, Section C, line 19 No such documents are available to the public. Ohio Farmers Insurance Co PO Box 5001 Westfield Center OH 44251 340438190 Insurance OH N/A C 0 Westfield Management Co PO Box 5001 Westfield Center OH 44251 341788314 N/A 0 Westfield Services Inc PO Box 5001 Westfield Center OH 44251 341861077 N/A 0 Westfield Bank FSB PO Box 5001 Westfield Center OH 44251 341940362 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1