TY 2015 Form 990

- TIN:

Form990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)

Do not enter social security numbers on this form as it may be made public.

Information about Form 990 and its instructions is at www.IRS.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
1700 28th Street SE

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
Grand Rapids, MI495081407

D Employer identification number

38-2425582

E Telephone number

G Gross receipts $ 5,799,515

F Name and address of principal officer:
John Bolt
1700 28th Street SE
Grand Rapids,MI495081407

Tax-exempt status: 501(c)(3) 501(c) ( 9 ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

www.crcna.org

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1982

M State of legal domicile: MI

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: Terminated Voluntary employee benefit plan for health, dental, and life insurance
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	30
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	30
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	-2,982	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	56,280	-1,511
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	53,298	-1,511
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	62,524	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	-5,984	0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,629,025	3,154,043
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,685,565	3,154,043
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,632,267	-3,155,554
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	3,155,554	0
21	Total liabilities (Part X, line 26).............	0	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,155,554	0

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name MediumBullet

Firm's EIN MediumBullet

Firm's address MediumBullet

Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2015)

Form 990 (2015)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part III ..............

Briefly describe the organization’s mission: Mutual membership benefits organization. This is a voluntary employee plan for health, dental, and life insurance

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 3,143,840 including grants of $ 0 ) (Revenue $ 0 )
	Distribution of remaining assets of the CGI program made to the new insurance program (Reformed Benefits Association) to cover ongoing insurance benefits premiums for participants.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses3,143,840

Form 990 (2015)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A.....................

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II..............

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III .............

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V......

If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI....................

11a

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............

11d

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X

11e

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X

11f

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional

12b

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....

20a

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

20b

Form 990 (2015)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J.......................

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............

24c

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................

25b

Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................

28a

A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I. Click to see attachment

Yes

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1......................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...

35b

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Form 990 (2015)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........

Yes

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)

Did the organization have unrelated business gross income of $1,000 or more during the year?...

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................

Did the sponsoring organization make any taxable distributions under section 4966?...

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.

13a

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....

13b

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Form 990 (2015)

Page 6

Part VI

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI ..............

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year

If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......

Yes

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....

12a

Did the organization have a written conflict of interest policy? If "No," go to line 13.......

12a

Yes

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

Chris Cok1700 28th Street SE Grand Rapids,MI495081407 (616) 224-0745

Form 990 (2015)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line in this Part VII ..............

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) Rev Peter De Vries...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(2) Dr R Scott Greenway...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(3) Rev Christian Y Oh...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(4) Rev Angela Taylor-Perry...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(5) Mr Peter Noteboom...................................................................... CRCNA Trustee Exec Committee	0 ................. 0	X	0	0	0
(6) Ms Katherine Vandergrift...................................................................... CRCNA Trustee President	0 ................. 0	X	0	0	0
(7) Rev William C Veenstra...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(8) Rev Kenneth Baker...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(9) Mr Kyu Paek...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(10) Mr Chris Van Spronsen...................................................................... CRCNA Trustee Vice President	0 ................. 0	X	0	0	0
(11) Ms Gavy Tran...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(12) Mr Michael Wevers...................................................................... CRCNA Trustee Exec Committee	0 ................. 0	X	0	0	0
(13) Mr David DeRidder...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(14) Rev Calvin Hoogendoom...................................................................... CRCNA Trustee, Vice-all	0 ................. 0	X	0	0	0
(15) Mrs Verney Kho...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(16) Mr Garry Sytsma...................................................................... CRCNA Trustee	0 ................. 0	X	0	0	0
(17) Dr Socorro Woodbury...................................................................... CRCNA Trustee, Exec Committee	0 ................. 0	X	0	0	0

Form 990 (2015)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Ms Elizabeth Rudenga........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(19) Rev Emmett Harrison........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(20) Mr Jose Tagle........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(21) Mr Randy Freeland........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(22) Ms Susan Hoekema........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(23) Mr Peter DeBoer........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(24) Mr Andy deRuyter........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(25) Rev Norman Visser........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(26) Rev Darrell Bierman........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(27) Rev Donald Draayer........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(28) Rev Shawn Brix........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(29) Mr Ralph Luimes........................................................................ CRCNA Trustee	0 .......................0	X		0	0	0
(30) Dr Steven Timmermans........................................................................ CRCNA Executive Director	0 .......................0	X	X	0	0	0
(31) John Bolt........................................................................ CFO	0 .......................0		X	0	0	0
(32) Michelle DeBie........................................................................ Benefits Director	0 .......................0		X	0	0	0
(33) Chris Cok........................................................................ Controller	0 .......................0		X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	0	0

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
Reformed Benefits Association 1700 28th Street Grand Rapids,MI495081407	Health and Life insurance premiums	3,143,840




2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 1

Form 990 (2015)

Page 9

Part VIII

Statement of Revenue

Check if Schedule O contains a response or note to any line in this Part VIII .............

(A)
Total revenue

(B)
Related or
exempt
function
revenue

(D)
Revenue
excluded from
tax under sections
512-514

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		0

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....		0

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			14,884	14,884	0	0
4 Income from investment of tax-exempt bond proceeds			0	0	0	0
5 Royalties...........			0	0	0	0
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0	5,784,631
b	Less: cost or other basis and sales expenses	0	5,801,026
c	Gain or (loss)	0	-16,395
d	Net gain or (loss).....			-16,395	-16,395	0	0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			-1,511	-1,511	0	0

Form 990 (2015)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	0	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	0	0	0	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	0	0	0	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0	0	0	0
9	Other employee benefits .......	0	0	0	0
10	Payroll taxes ...........	0	0	0	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	0	0	0	0
c	Accounting ...........	5,825	0	5,825	0
d	Lobbying ...........	0	0	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	4,378	0	4,378	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	0	0	0	0
12	Advertising and promotion ....	0	0	0	0
13	Office expenses .......	0	0	0	0
14	Information technology ......	0	0	0	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	0	0	0	0
17	Travel ............	0	0	0	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	0	0	0	0
20	Interest ...........	0	0	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	0	0	0	0
23	Insurance ...	3,143,840	3,143,840	0	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	3,154,043	3,143,840	10,203	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Form 990 (2015)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX ..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........		429,342	1	0
2	Savings and temporary cash investments .........		0	2	0
3	Pledges and grants receivable, net ......		0	3	0
4	Accounts receivable, net .............		12,393	4	0
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
			0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			0	6	0
7	Notes and loans receivable, net ....		0	7	0
8	Inventories for sale or use ........		0	8	0
9	Prepaid expenses and deferred charges ......		0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b	0	10c
11	Investments—publicly traded securities .		2,700,460	11	0
12	Investments—other securities. See Part IV, line 11 .....		0	12	0
13	Investments—program-related. See Part IV, line 11 ..		0	13	0
14	Intangible assets ...............		0	14	0
15	Other assets. See Part IV, line 11 ...........		13,359	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...		3,155,554	16	0

17	Accounts payable and accrued expenses .....	0	17	0
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	0	25
26	Total liabilities. Add lines 17 through 25..	0	26	0

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	3,155,554	27	0
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	3,155,554	33	0
34	Total liabilities and net assets/fund balances ........	3,155,554	34	0

Form 990 (2015)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI ..............

Total revenue (must equal Part VIII, column (A), line 12) ............

-1,511

Total expenses (must equal Part IX, column (A), line 25) ............

3,154,043

Revenue less expenses. Subtract line 2 from line 1 ..............

-3,155,554

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

3,155,554

Net unrealized gains (losses) on investments ...............

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII .............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

Form 990 (2015)

Additional Data

Software ID:	15000352
Software Version:	v1.00

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

Information about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR

Employer identification number
38-2425582

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Cash	01-08-2015	363,423	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	01-29-2015	76,901	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	02-05-2015	246,002	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	03-05-2015	233,948	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	04-13-2015	236,796	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	04-16-2015	171,033	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	05-05-2015	235,852	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	05-21-2015	37,872	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	06-04-2015	39,029	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	06-05-2015	235,790	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	06-25-2015	17,228	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	07-06-2015	238,915	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	07-16-2015	35,148	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI485081407	501(c)3
Cash	08-05-2015	236,556	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	08-20-2015	40,736	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	09-08-2015	232,436	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	09-10-2015	40,596	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	10-01-2015	58,905	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	10-05-2015	230,573	Cash Value	46-2975745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3
Cash	11-05-2015	136,101	Cash Value	46-2974745	Reformed Benefits Association 1700 28th Street SE Grand Rapids,MI495081407	501(c)3

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Yes

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2015)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Yes

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

If "Yes," did the organization provide such notice? .....................

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Yes

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .....................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? .....................

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

Schedule N(Form 990 or 990-EZ) (2015)

Schedule N (Form 990 or 990-EZ) (2015)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation
Schedule N, Part I, Line 2	The CGI plan was dissolved when the Reformed Benefits Association (or RBA) was established to replace it. When RBA was established, it was decided that each of the two founding member organizations of the RBA would have three board members and one non-voting board trustee member who would function as either the Secretary or Treasurer. During the 2015 year the Trustee Secretary and Treasurer positions became full voting member positions on the Board of RBA. The former officers of CGI, John Bolt, the CRCNA/CGI CFO, took the office of Trustee and Treasurer (Currently a voting position of the RBA Board of Trustees), and Michelle DeBie, the CRCNA/CGI Benefits Director, became an officer in the RBA as the Benefits Director.

Return Reference

Explanation

Schedule N, Part I, Line 2

The CGI plan was dissolved when the Reformed Benefits Association (or RBA) was established to replace it. When RBA was established, it was decided that each of the two founding member organizations of the RBA would have three board members and one non-voting board trustee member who would function as either the Secretary or Treasurer. During the 2015 year the Trustee Secretary and Treasurer positions became full voting member positions on the Board of RBA. The former officers of CGI, John Bolt, the CRCNA/CGI CFO, took the office of Trustee and Treasurer (Currently a voting position of the RBA Board of Trustees), and Michelle DeBie, the CRCNA/CGI Benefits Director, became an officer in the RBA as the Benefits Director.

Schedule N (Form 990 or 990-EZ) (2015)

Additional Data

Software ID:	15000352
Software Version:	v1.00

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR

Employer identification number

38-2425582

Return Reference	Explanation
Form 990, Header, Line B	Form 990, Header Line B: - In 2013 an agreement to create an insurance organization jointly with another church denomination was reached. This new organization, The Reformed Benefits Association (or RBA) was incorporated as a 501(c)3 organization. RBA was created to replace the Christian Reformed Church in North America Vountary Participant Benefit Trust (or CGI). The CGI plan provided insurance benefits through December 31, 2013, and on January 1, 2014 the RBA began operations. All financial obligations of the CGI medical and life insurance plans were resolved prior to the end of 2014. Ongoing banking, investment management, and audit review costs, incurred in 2015 were paid. No 2015 CRCNA operating expenses were allocated to the CGI plan. In order to comply with the CGI plan documents that state that CGI plan funds will be used for the exclusive benefit of the plan participants, once all CGI obligations had been resolved the remaining plan funds were used to pay ongoing insurance premiums of the CRCNA and CRCNA affiliated agency employees to the RBA.
Form 990, Header, Line C	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.
Form 990, Part III, Line 3	Form 990, Part III, Line 3: The Christian Reformed Church in North America Voluntary Participant Benefit Trust (or CGI) ceased all operations of Health, Dental and Life insurance coverage to the Christian Reformed Church in North America (or CRCNA) participants. The CRCNA entered into an agreement with another church denomination to start up a joint non-profit company to provide and administer Health, Dental, and Life insurance to all former eligible participants. This new company, Reformed Benefits Association (or RBA) effectively began the Health, Dental and Life insurance coverage of CRCNA participants on January 1st of 2014. All remaining obligations of CGI were resolved during the 2014 year and all remaining assets have been transferred to the RBA by paying the current premiums for CRCNA participants in RBA
Form 990, Part VI, Section A, Line 9	Rev. Peter De Vries, 8756 Alta Cove Dr, Sandy UT 84093 : Rev R. Scott Greenway, 9957 Cherry Valley, Caledonia MI 49316 : Rev. Christian Y Oh, 1849 Livernois, Rochester Hills MI 48307 : Rev. Angela Taylor-Perry, 306 Candlewyck Dr #1504, Kalamazoo MI 49001 : Mr. Peter Noteboom, (Executive Committee), 147 Springhurst Ave, Toronto ON M6K 1B9 : Ms. Katherine Vandergrift, (Executive Committee), 937 Alpine Ave, Ottawa ON K2B 5R9 : Rev. William C Veenstra, 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 90630 : Mr. Chris Van Spronsen, (Executive Committee), 3517 Bennet Rd, Saranac MI 48881 : Ms. Gavy Tran, #13 - 3087 Immel St, Abbotsford BC V2S 6Z6 : Mr. Michael Wevers, (Executive Committee), 9320 161 St, Edmonton AB T5R 2L4 : Mr. David DeRidder, 6932 Vassar Ave, Denver CO 80224 : Rev. Calvin Hoogendoorn, (Executive Committee), 4923 South Lewis Ave, Sioux Falls SD 57108 : Mrs. Verney Kho, 7711 N 5 Rd, Richmond BC V6Y 2V3 : Mr. Garry Sytsma, 400 - 3rd Line Rd R.R. #3, Hagersville ON N0A 1H0 : Dr. Socorro Woodbury, (Executive Committee), 664 11th Ave NE, Sioux Center IA 51250 : Ms. Elizabeth Rudenga, 2608 Hart St, Dyer IN 46311 : Rev Emmett Harrison, 1000 Hancock SE, Grand Rapids MI 49507 : Mr Jose Tagle, 114 Bayberry Circle, Jupiter FL 33458 : Mr Randy Freeland, PO Box 3900, Gallup NM 87305 : Ms. Susan Hoekema, 10187 Lakeshore Dr, West Olive MI 49460 : Mr Peter DeBoer, 55 Prominence Point SW, Calgary AB T3H 3E8 : Mr Andy deRuyter, 22591 McClinton Ave, Richmond BC V6V 2P8 : Rev Norman Visser, 17 Greenwood Rd, Ingersoll ON N5C 3N2 : Rev Darrell Bierman, 59 Rose Bridge Cres, Cambridge ON N3C 3Z3 : Rev Donald Draayer, 249 Pritchard Farm Rd, East St Paul MB R2E 0B5 : Rev Shawn Brix, 2121 Asphodel 4th Line RR3, Norwood ON K0L 2V0 : Mr Ralph Luimes, 320 Greens Rd, Caledonia ON N3W 1X3 : Mr. Mark Charles, P.O. Box 2672, Fort Defiance AZ 86504 : Ms. Joan Flikkema, 1060 Cherrywood Lane NE, Grand Rapids MI 49505 : Rev. Sheila Holmes, 167 North 7th St, Paterson NJ 07522 : 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, Caledonia ON N3W 0A4 : Rev. Dale Melenberg, 4822 - 21 Ave NW, Calgary AB T3B 0W9 : Ms. Grace Miedema, 75 Water St, Aylmer ON N5H 1H1 : Rev. Trevor Vanderveen, 2181 East 13th Ave., Vancouver BC V5N 2C6 : Dr. Peter Szto, 3334 N 125th Ave, Omaha NE 68164 : Rev. Harold de Jong, 14 Cedar Lane, Rosslyn ON P7K 0M9 : Rev. Darren Roorda, 386 Townsend Dr, Breslau ON N0B 1M0 : Mr. Bert Witvoet, 73 Highland Ave, St Catharines ON L2R 4H9 :
Form 990, Part VI, Section B, Line 11b	990 Part VI Section A Line 11b: 990 Process: The 990 form and all required schedules are completed by the Accountant and reviewed by the Controller. The completed forms were forwarded to the CRCNA CFO prior to being submitted to the IRS.
Form 990, Part VI, Section B, Line 12c	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	990 Part VI Section B Line 15 a & b: All CRCNA compensated employee positions, including any Officer and Director positions were evaluated by CAC and an outside group (HayGroup) to determine position grades or levels. Each grade was then assigned an Pay Scale based on Internal, Individual, and External Equity. These Pay Grades and Pay Scales are reviewed by CAC, and the revised compensation package is sent to CRCNA Board of Trustees for ratification.
Form 990, Part VI, Section C, Line 19	990 Part VI Section C Line 19: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.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000352
Software Version:	v1.00

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

CHRISTIAN REFORMED CHURCH-N AMER VOLUNTARY PARTICIPANT BENE PL TR

Employer identification number

38-2425582

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Christian Reformed Church in North America 1700 28th Street SE Grand Rapids,MI495081407 38-2051351	Religous	MI	501(c)3	1	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000352
Software Version:	v1.00