2014-08-14T09:21:47-07:00 2013-12-31 990 2013-01-01 382425582 CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR CHRI 6162240745 1700 28th Street SE Grand Rapids MI 495081407 Chris Cok Controller 6162240745 2014-08-14 2013 2015-11-30 17:44:51Z X John Bolt 1700 28th Street SE Grand Rapids MI 495081407 11972090 0 X www.crcna.org X 1982 MI Voluntary employee plan for health, dental, and life insurance 30 30 0 0 0 0 0 0 10851501 10218650 89563 51507 0 0 10941064 10270157 0 0 7911623 6453118 190018 177489 0 0 0 2049703 2234517 10151344 8865124 789720 1405033 3594640 4900355 185966 117399 3408674 4782956 Mutual membership benefits organization. This is a voluntary employee plan for health, dental, and life insurance 0 0 8504990 0 10270157 Voluntary benefits including health, dental, and life insurance serving 853 members, their beneficiaries and dependants 0 0 0 8504990 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 X 30 30 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 0 X X Chris Cok 6162240745 1700 28th Street SE Grand Rapids MI 495081407 Mr Mark Charles CRCNA Trustee 0 0 X 0 0 0 Rev Peter De Vries CRCNA Trustee 0 0 X 0 0 0 Ms Joan Flikkema CRCNA Trustee 0 0 X 0 0 0 Dr R Scott Greenway CRCNA Trustee Vice-All 0 0 X 0 0 0 Rev Sheila Holmes CRCNA Trustee President 0 0 X 0 0 0 Rev Christian Y Oh CRCNA Trustee 0 0 X 0 0 0 Rev Angela Taylor-Perry CRCNA Trustee 0 0 X 0 0 0 Rev John Terpstra CRCNA Trustee President (outgoing) 0 0 X 0 0 0 Rev Gary Van Engelenhoven CRCNA Trustee (outgoing) 0 0 X 0 0 0 Mr Loren Veldhuizen CRCNA Trustee 0 0 X 0 0 0 Mr Wybe Bylsma CRCNA Trustee 0 0 X 0 0 0 Mr Bruce Dykstra CRCNA Trustee 0 0 X 0 0 0 Rev Dale Melenberg CRCNA Trustee 0 0 X 0 0 0 Ms Grace Miedema CRCNA Trustee 0 0 X 0 0 0 Mr Peter Noteboom CRCNA Trustee 0 0 X 0 0 0 Ms Katherine Vandergrift CRCNA Trustee Vice President 0 0 X 0 0 0 Rev Trevor Vanderveen CRCNA Trustee 0 0 X 0 0 0 Rev William C Veenstra CRCNA Trustee Exec Committee 0 0 X 0 0 0 Rev Kenneth Baker CRCNA Trustee 0 0 X 0 0 0 Mr Kyu Paek CRCNA Trustee 0 0 X 0 0 0 Dr Peter Szto CRCNA Trustee 0 0 X 0 0 0 Dr Steven Timmermans CRCNA Trustee 0 0 X 0 0 0 Mr Chris Van Spronsen CRCNA Trustee Exec Committee 0 0 X 0 0 0 Rev Harold de Jong CRCNA Trustee 0 0 X 0 0 0 Ms Elaine Dee CRCNA Trustee (outgoing) 0 0 X 0 0 0 Rev Darren Roorda CRCNA Trustee Exec Committee 0 0 X 0 0 0 Ms Gavy Tran CRCNA Trustee 0 0 X 0 0 0 Mr Michael Wevers CRCNA Trustee 0 0 X 0 0 0 Mr Bert Witvoet CRCNA Trustee 0 0 X 0 0 0 Mr David DeRidder CRCNA Trustee 0 0 X 0 0 0 Rev Calvin Hoogendoom CRCNA Trustee 0 0 X 0 0 0 Mrs Verney Kho CRCNA Trustee 0 0 X 0 0 0 Mr Garry Sytsma CRCNA Trustee 0 0 X 0 0 0 Joel Boot CRCNA Executive Director 0 0 X 0 0 0 John Bolt CFO 6.1 X 0 23500 6162 Michelle DeBie Benefits Director 18 X 0 48200 11257 Chris Cok Controller 3.4 X 0 9900 2259 0 81600 19678 0 0 0 0 Blue Cross Blue Shield of Michigan PO Box 4407 Detroit MI 48277 Manage medical health plan 420633 1 0 Participant Premiums 525100 10218650 10218650 0 0 0 0 0 0 10218650 106408 106408 0 0 0 0 0 0 0 0 0 0 0 0 1647032 0 1701933 0 -54901 0 -54901 -54901 0 0 0 10270157 10270157 0 0 0 0 0 0 0 0 6453118 6453118 81600 0 81600 0 0 0 0 0 54470 0 54470 0 13607 0 13607 0 21259 0 21259 0 6553 0 6553 0 485520 485520 0 0 6354 0 6354 0 5450 0 5450 0 0 0 0 0 0 0 12509 0 12509 0 0 0 0 0 0 0 0 0 112853 0 112853 0 34592 0 34592 0 0 0 0 0 10624 0 10624 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 1566615 1566352 263 0 8865124 8504990 360134 0 678527 1799820 0 0 0 0 409505 466469 0 0 0 0 0 0 0 0 397034 0 0 2092959 2618863 0 0 0 0 0 0 16615 15203 3594640 4900355 47911 117399 0 0 138055 0 0 0 0 0 0 0 0 0 0 0 0 0 185966 117399 X 3408674 4782956 0 0 0 0 3408674 4782956 3594640 4900355 1405033 -30751 0 0 0 0 X 1 X 0 1 0 0 0 X 10239406 -30751 0 0 0 -30751 10270157 0 0 0 10270157 8865124 0 0 0 0 0 8865124 0 0 0 8865124 Schedule D, Part X, Line 2 FIN 48 footnote from financials related to uncertain tax positions: Plan management has analyzed the tax positions taken by the plan and has concluded that as of Dec 31, 2013 and 2012 there are no uncertain positions taking or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. Form 990, Header, Line C Explanation of the relationship between the Benefit Trust (or CGI) and the Christian Reformed Church in North America (or CRCNA). -CGI was created to provide health insurance benefits to the CRCNA agency affiliate employees and member church employees. The CRCNA exists to provide administrative support for the church. The management of CGI consists of a Human Resource Committee (or HRC), and all changes to policies or revisions to the insurance plans are submitted from HRC to the CRCNA Board of Trustees for approval. The CRCNA Board of Trustees is comprised of 30 voting members, none of whom are officers, directors of employees of CRCNA, and one non-voting member -the executive director of the CRCNA. For purposes of the 990 form and any completed schedules, questions in reference to the Governing Body, or Trustees are completed based on the current CRCNA Board of Trustees information. Policy questions referencing officers, directors or employees are completed based on CRCNA policies. Questions referencing the organization, and all financial information are based on CGI policies or information. Form 990, Part VI, Section A, Line 9 Mr. Mark Charles, P.O. Box 2672, Fort Defiance AZ 86504 : Rev. Peter De Vries, 8756 Alta Cove Dr, Sandy UT 84093 : Ms. Joan Flikkema, 1060 Cherrywood Lane NE, Grand Rapids MI 49505 : Rev R.Scott Greenway, (Executive Committee), 9957 Cherry Valley, Caledonia MI 49316 : Rev. Sheila Holmes, (Executive Committee), 167 North 7th St, Paterson NJ 07522 : Rev. Christian Y Oh, 1849 Livernois, Rochester Hills MI 48307 : Rev. Angela Taylor-Perry, 306 Candlewyck Dr, Kalamazoo MI 490001 : Mr. David DeRidder, 6932 Vassar Ave, Denver CO 80224 : Rev. Calvin Hoogendoorn, 4923 South Lewis Ave, Sioux Falls SD 57108 : Mr. Loren Veldhuizen, 105 18th St NW, Orange City IA 51041 : Mr. Wybe Bylsma, 2606 Cap Wilson Rd, Unit 175, Cobourg ON K9A 4J9 : Mr. Bruce Dykstra, 25 Iron Bridge Ct, Caladonia ON N3W 0A4 : Rev. Dale Melenberg, 4822 - 21 Ave NW, Calgary AB T3B 0W9 : Ms. Grace Miedema, 75 Water St, Aylmer ON N5H 1H1 : Mr. Peter Noteboom, 147 Springhurst Ave, Toronto ON M6K 1B9 : Ms. Katherine Vandergrift, (Executive Committee), 937 Alpine Ave, Ottawa ON K2B 5R9 : Rev. Trevor Vanderveen, 2181 East 13th Ave., Vancouver BC V5N 2C6 : Mrs. Verney Kho, 7711 N 5 Rd, Richmond BC V6Y 2V3 : Rev. Kenneth Baker, 6379 Old Log Trail, Kalamazoo MI 49009 : Mr. Kyu Paek, 8208 Peppertree Lane, Cypress CA 84093 : Dr. Peter Szto, 3334 N 125th Ave, Omaha NE 68164 : Dr. Steven Timmermans, 6601 West College Dr, Palos Heights IL 60463 : Mr. Chris Van Spronsen, (Executive Committee), 3517 Bennet Rd, Saranac MI 48881 : Rev. Harold de Jong, 14 Cegar Lane, Rosslyn ON P7K 0M9 : Rev. William C Veenstra, (Executive Committee), 9800 McNaught Rd, Chilliwack BC V2P 6G2 : Rev. Darren Roorda, (Executive Committee), 386 Townsend Dr, Breslau ON N0B 1M0 : Ms. Gavy Tran, 13 3087 Immel St, Abbotsford BC V2S 6Z6 : Mr. Michael Wevers, 9320 161 St, Edmonton AB T4R 2L4 : Mr. Bert Witvoet, 73 Highland Ave, St Catharines ON L2R 4H9 : Mr. Garry Sytsma, 400 - 3rd Line Rd R.R. #3, Hagersville ON N0A 1H0 : Form 990, Part VI, Section B, Line 11b 990 Completion and review process: The 990 form and all required schedules are completed by the Finance Manager and reviewed by the Controller. The completed forms are then forwarded to the current Finance committee of the CRCNA Board of Trustees prior to being submitted to the IRS. The Finance committee is comprised of the CRCNA CFO, selected board members, and financial professionals. Form 990, Part VI, Section B, Line 12c Compliance to the Conflict of Interest Policy procedure: The September CRCNA Annual Board meeting itinerary includes the distribution of an Orientation Package which includes the Conflict of Interest Policy. Any new Board members are required to complete and sign the included policy compliance package. Any existing members are requested to review the Compliance package and resubmit the Compliance form if any changes have occurred. Form 990, Part VI, Section B, Line 15 Compensation review and approval: All CRCNA compensated employee positions, including any officer and director positions were evaluated by HRC and an outside group to determine position grades or levels. Each grade was then assigned a Pay Scale based on Internal, Individual, and External Equity. These Pay Grades and Pay Scales are annually reviewed by HRC and the revised compensation package is sent to the CRCNA Board of Trustees for ratification. Form 990, Part VI, Section C, Line 19 Public document availability: The CRCNA Governing Documents and Conflict of Interest Policy are available on the CRCNA public website (www.crcna.org), Financial Statements are available on request. Christian Reformed Church in North America 1700 28th Street SE Grand Rapids MI 495081407 382051351 Religous MI 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 10624 Allocation Christian Reformed Church in North America o 177490 Allocation Christian Reformed Church in North America p 56241 Allocation Extension request was filed to allow time for completion of financial statement review by auditors.