2023-10-11T09:48:02-07:00 2022-12-31 990 2022-01-01 462975745 REFORMED BENEFITS ASSOCIATION REFO 6162240716 4500 60th Street SE Grand Rapids MI 49512 Nicole Huttenga Director 6162245889 2023-10-11 1 1 11 1 AAL2 X 2022 2023-04-26 12:10:37Z X Nicole Huttenga 4500 60th Street SE Grand Rapids MI 49512 14550484 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 49054 0 0 0 15045144 14496489 41933 49054 0 0 15087077 14545543 0 0 8996715 9334292 302920 283889 0 0 0 5086956 5024638 14386591 14642819 700486 -97276 9561157 9539770 1731532 1936646 7829625 7603124 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 14133263 0 14496048 Management and Administration services of health and welfare benefit plans for employees of its members and other eligible participating organizations. 0 0 0 14133263 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Nicole Huttenga 6162240831 4500 60th Street SE Grand Rapids MI 49512 X Kelly Oliveria Board Secretary 4 40 X X 0 111474 38498 Nicole Huttenga Director 40 40 X 0 92185 44147 John Bolt Board Treasurer, Outgoing 4 40 X X 0 93854 26675 Carol Koppenaal Board Member, Interim Treasurer 4 40 X X 0 42675 9001 Nancy DeGood Board President 0 0 X 0 0 0 Trevor Deters Board Vice President 0 0 X 0 0 0 James Kuplic Board Member 0 0 X 0 0 0 Joel Vande Werken Board Member 0 0 X 0 0 0 Karen Walker Board Member 0 0 X 0 0 0 Leanne Bough Board Member 0 0 X 0 0 0 Dana Chapman Board Member, Outgoing-Resigned 0 0 X 0 0 0 0 340188 118321 3 0 0 0 UMR Inc 11 Scott Street Suite 100 Wausau WI 544034888 Heath Plan Claims Administration 314555 Quantum Health Inc 7450 Huntington Park Dr Columbus OH 43235 Participant Assistance Services 404922 2 0 Participant Premiums 525100 14496489 14496489 0 0 0 0 0 0 14496489 49495 0 49495 0 0 0 0 0 0 0 0 0 0 0 4500 0 4941 0 -441 0 -441 0 -441 0 0 14545543 14496489 49054 0 0 0 0 0 0 0 9334292 9334292 159661 0 159661 0 0 0 0 0 70505 0 70505 0 7755 0 7755 0 31771 0 31771 0 14197 0 14197 0 766481 766481 0 0 3825 0 3825 0 84898 0 84898 0 0 0 0 0 0 0 4675 0 4675 0 0 0 0 0 565 0 565 0 99623 0 99623 0 14272 0 14272 0 0 0 0 0 5361 0 5361 0 1945 0 1945 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4039351 4028848 10503 0 PCOR (Patient-Centered Outcomes Research Fee) 3642 3642 0 0 0 0 0 0 14642819 14133263 509556 0 8128657 8161338 0 0 0 0 13988 80203 0 0 0 0 0 0 0 0 191735 157508 0 1226777 1140721 0 0 0 0 0 0 0 0 9561157 9539770 1659809 1928393 0 0 71723 8253 0 0 0 0 0 0 0 0 0 0 0 0 1731532 1936646 X 7829625 7603124 0 0 7829625 7603124 9561157 9539770 -97276 -129225 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 Benefit 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 0 0 X 14416318 -129225 0 0 0 -129225 14545543 0 0 0 14545543 14642819 0 0 0 0 0 14642819 0 0 0 14642819 Schedule D, Part X, Line 2 Financial Statement Footnote of uncertain tax positions: In a determination letter dated August 29, 2014, RBA was informed that the organization is tax exempt under section 501c(3) of the Internal Revenue Code. RBA is not aware of any material uncertain tax positions. Form 990, Part VI, Section A, Line 4 Significant changes to governing documents: The original RBA By-Laws regarding the make up of the Board of Trustees included 6 Voting Trustees and 2 Ex-officio Non-Voting Trustees. 3 Voting Trustees and 1 Non Voting Trustee were appointed by each of the member organizations. The By-Laws were amended (2015) to change the 2 Ex-officio Non-voting Trustee positions to 2 Staff Voting Trustee positions. Each member organization will appoint one denominational executive employee as a Staff Voting Trustee. 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 B, Line 11b Review of the 990 form: The 990 form is completed by the Finance Manager and reviewed by the current (2023) Board Treasurer and RBA Director 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 Governing 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 49508 382051351 Religious MI 501(c)(3) 1 N/A 0 Reformed Church in America Board of Benefit Services 475 Riverside Dr Ste 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 4446 Allocation Reformed Church in America Board of Benefit Services n 915 Contracted rental agreement, and allocation Christian Reformed Church in North America o 267076 Mix of Acutual Employee costs and Allocations Reformed Church in America Board of Benefit Services o 16813 Agreed on percentage of Actual Employee cost Christian Reformed Church in North America p 75188 Allocation Extension was requested to allow time for completion of the independent audit.