Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 3 | PRIOR TO 2013 HEALTH, DENTAL AND PRESCRIPTION DRUG BENEFITS WERE SELF FUNDED BY THE TRUST. EFFECTIVE JANUARY 1, 2013 ALL BENEFITS WERE PROVIDED BY INSURANCE POLICIES ISSUED BY WPS. |
| FORM 990, PART VI, SECTION A, LINE 3 | EBC PERFORMS ADMINISTRATIVE SERVICES AND SERVES AN ADVISORY ROLE TO THE TRUST AND BIC. THE SERVICES PERFORMED ARE IN ACCORDANCE WITH THE ADMINISTRATIVE SERVICES AGREEMENT. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WAS PROVIDED TO THE GOVERNING BODY OF THE ORGANIZATION BEFORE IT WAS FILED. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| FORM 990, PART VII | MARY JANE HAAS IS COMPENSATED THROUGH EBC, AN UNRELATED THIRD PARTY. |
| SCHEDULE N, PART II, LINE 1 | PRIOR TO 2013, THE TRUST HAD A MODIFIED PREMIUM AND ADMINISTRATIVE SERVICES AGREEMENT WITH WPS, AN INDEPENDENT THIRD PARTY, FOR MEDICAL, DENTAL AND PRESCRIPTION DRUG BENEFITS. UNDER THIS AGREEMENT, THE AMOUNT PAID TO WPS FOR CLAIMS ADMINISTRATIVE SERVICES WAS A SPECIFIED DOLLAR AMOUNT PER CONTRACT PER MONTH FOR MEDICAL, DENTAL AND PRESCRIPTION CLAIMS. OTHER ADMINISTRATIVE CHARGES, COMMISSIONS AND OTHER MISCELLANEOUS CHARGES WERE BASED ON ACTUAL COSTS. VISION, LIFE, DEPENDENT LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, LONG-TERM DISABILITY, AND SHORT TERM DISABILITY BENEFITS WERE PROVIDED EXCLUSIVELY BY FULLY INSURED POLICIES ISSUED TO THE TRUST. IN NOVEMBER 2012, THE BOARD OF DIRECTORS OF THE TRUST ENTERED INTO A RISK MODIFICATION AGREEMENT WITH WPS TO TERMINATE THE MODIFIED PREMIUM AND ADMINISTRATIVE SERVICE AGREEMENT AND THE WPS STOP LOSS POLICY AND TO PURCHASE A FULLY INSURED MEDICAL POLICY FROM WPS EFFECTIVE JANUARY 1, 2013. THE RISK MODIFICATION AGREEMENT ALSO PROVIDED FOR THE TRUST TO PAY WPS ALL MONIES RESERVED BY THE TRUST FOR PAYMENT OF CLAIMS AND COSTS ASSOCIATED WITH THE CLAIMS INCURRED AND REPORTED TO WPS PRIOR TO JANUARY 1, 2013, BUT NOT YET PAID PRIOR TO JANUARY 1, 2013, AND FOR CLAIMS INCURRED PRIOR TO JANUARY 1, 2013 BUT NOT YET REPORTED TO WPS BY JANUARY 1, 2013. THE TOTAL AMOUNT PAID TO SETTLE THESE OBLIGATIONS WAS $4,013,433, WHICH REPRESENTED A SIGNIFICANT PORTION OF THE TRUST'S ASSETS. GOING FORWARD, THE TRUST WILL RETAIN ONLY A REASONABLE AMOUNT OF ASSETS TO COVER ITS ADMINISTRATIVE EXPENSES SINCE THE BENEFITS PROVIDED ARE NOW FULLY INSURED. |
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