2013-08-06T09:41:12-07:00 2012-12-31 990 2012-01-01 382425582 CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR CHRI 6162240745 2850 Kalamazoo Ave SE Grand Rapids MI 49560 Chris Cok 6162240745 2013-08-06 2012 2016-02-24 21:20:13Z John Bolt 2850 Kalamazoo Ave SE Grand Rapids MI 49560 12451562 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 10531150 10851501 91154 89563 0 0 10622304 10941064 0 0 8678922 7911623 180366 190018 0 0 0 2058476 2049703 10917764 10151344 -295460 789720 2751986 3594640 105204 185966 2646782 3408674 Mutual membership benefits organization. This is a voluntary employee plan for health, dental, and life insurance 0 0 9806460 0 10941064 Voluntary benefits including health, dental, and life insurance serving 892 members, their beneficiaries and dependants 0 0 0 9806460 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 2850 Kalamazoo Ave SE Grand Rapids MI 49560 Mr Mark Charles 0 0 X 0 0 0 Rev Peter De Vries 0 0 X 0 0 0 Ms Joan Flikkema 0 0 X 0 0 0 Dr R Scott Greenway 0 0 X 0 0 0 Rev Sheila Holmes 0 0 X 0 0 0 Rev Christian Y Oh 0 0 X 0 0 0 Rev Angela Taylor-Perry 0 0 X 0 0 0 Rev John Terpstra 0 0 X 0 0 0 Rev Gary Van Engelenhoven 0 0 X 0 0 0 Mr Loren Veldhuizen 0 0 X 0 0 0 Mr Wybe Bylsma 0 0 X 0 0 0 Mr Bruce Dykstra 0 0 X 0 0 0 Rev Dale Melenberg 0 0 X 0 0 0 Ms Grace Miedema 0 0 X 0 0 0 Mr Peter Noteboom 0 0 X 0 0 0 Ms Katherine Vandergrift 0 0 X 0 0 0 Rev Trevor Vanderveen 0 0 X 0 0 0 Rev William C Veenstra 0 0 X 0 0 0 Rev Kenneth Baker 0 0 X 0 0 0 Mr Kyu Paek 0 0 X 0 0 0 Dr Peter Szto 0 0 X 0 0 0 Dr Steven Timmermans 0 0 X 0 0 0 Mr Chris Van Spronsen 0 0 X 0 0 0 Rev Harold de Jong 0 0 X 0 0 0 Ms Elaine Dee 0 0 X 0 0 0 Rev Darren Roorda 0 0 X 0 0 0 Ms Gavy Tran 0 0 X 0 0 0 Mr Michael Wevers 0 0 X 0 0 0 Mr Bert Witvoet 0 0 X 0 0 0 Rev Robert A Lyzenga 0 0 X 0 0 0 Rev Eleanor M Rietkerk 0 0 X 0 0 0 Joel Boot 0 0 X 0 0 0 John Bolt 6.1 0 X 0 22892 5723 Michelle DeBie 18 0 X 0 47250 7104 Chris Cok 3.4 0 X 0 9721 2288 0 79863 15115 0 0 0 0 Blue Cross Blue Shield of Michigan PO Box 4407 Detroit MI 48277 Manage medical health plan 227671 1 0 Participant premiums 525100 10851501 10851501 0 0 0 0 0 0 10851501 112276 112276 0 0 0 0 0 0 0 0 0 0 0 0 1487785 0 1510498 0 -22713 0 -22713 -22713 0 0 0 10941064 10941064 0 0 0 0 0 0 0 0 7911623 7911623 79863 0 79863 0 0 0 0 0 67116 0 67116 0 11827 0 11827 0 23878 0 23878 0 7334 0 7334 0 238924 238924 0 0 3282 0 3282 0 5300 0 5300 0 0 0 0 0 0 0 13606 0 13606 0 0 0 0 0 0 0 0 0 71616 0 71616 0 49235 0 49235 0 0 0 0 0 11656 0 11656 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 1656084 1655913 171 0 0 0 0 0 10151344 9806460 344884 0 94319 678527 0 0 0 0 131336 409505 0 0 0 0 0 0 0 0 441499 397034 0 2067336 2092959 0 0 0 0 0 0 17496 16615 2751986 3594640 54642 47911 0 0 50562 138055 0 0 0 0 0 0 0 0 0 0 0 0 105204 185966 X 2646782 3408674 0 0 0 0 2646782 3408674 2751986 3594640 789720 -27828 0 0 0 0 X 1 X 0 1 0 0 0 X 10913236 -27828 0 0 0 -27828 10941064 0 0 0 10941064 10151344 0 0 0 0 0 10151344 0 0 0 10151344 SchD_P10_S00_L02 Schedule D, Part X, Line 2 FIN 48 Footnote from financials related to uncertian tax positions: Plan management has analyzed the tax positions taken by the Plan and has concluded that as of December 31, 2012 and 2011 there are no uncertian positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. F990_P00_S00_L0C 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, or employees of CRCNA, and one non-voting member -the executive director of 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. F990_P06_S0A_L09 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 : Rev. John Terpstra, (Executive Committee), 3221 W Prospect Rd, Fort Collins CO 80526 : Rev. Gary Van Engelenhoven, 702 - 2nd Avenue E, Oskaloosa IA 52577 : 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, (Executive Committee), 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 : Rev. William C Veenstra, (Executive Committee), 9800 McNaught Rd, Chilliwack BC V2P 6G2 : 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, 3517 Bennet Rd, Saranac MI 48881 : Rev. Harold de Jong, 14 Cegar Lane, Rosslyn ON P7K 0M9 : Ms. Elaine Dee, Unit 3 10171 No1 Rd, Richmond BC V7E 1S1 : Rev. Darren Roorda, 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 : Rev. Robert A. Lyzenga, 1818 Whisper Valley Dr, Lafayette IN 47909 : Rev. Eleanor M. Rietkerk, 15229 12th Dr SE, Mill Creek WA 98012 : F990_P06_S0B_L11b 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 memebers, and financial professionals. F990_P06_S0B_L12c 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. F990_P06_S0B_L15 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. F990_P06_S0C_L19 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 2850 Kalamazoo Ave SE Grand Rapids MI 49560 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 11656 Allocation Christian Reformed Church in North America o 190018 Allocation Christian Reformed Church in North America p 68844 Allocations Extention request was filed to allow time for completion of financial statement review by auditors