US Dept of Treasury IRS 10/14/2020

Form 1024(Rev.1-2018) Page 14 Schedule F Organizations described in section 501(c)(9) (Voluntary employees' beneficiary associations) 1 Describe the benefits available to members.Include copies of any plan documents that describe such benefits and the terms and conditions of eligibility for each benefit. Participants are able to be reimbursed for eligible health care expenses as defined in section 213(d)of the Internal Revenue Code, excluding expenses for qualified long term care services as described in section 106 of the Internal Revenue Code and contributions to a qualified medical savings account.Attached please find the following: • Adoption Agreement and Basic Plan Document for the City of Everett Fire HRA VEBA Plan ` Adoption Agreement and Basic Plan Document for the City of Everett Fire PRA VEBA Plan * Adoption Agreement and Basic Plan Document for the City of Everett HRA VEBA Plan * Adoption Agreement and Basic Plan Document for the City of Everett PRA VEBA Plan 2 Are any employees or classes of employees entitled to benefits to which other employees or classes of employees are not entitled'? i✓ Yes ❑No If"Yes,"explain. See Attachment A. 3 Give the following information for each plan as of the last day of the most recent plan year and enter that date here. If there is more than one plan,attach a separate schedule 0 6/3 0/2 0 2 0 (mo.) (day) (yr.) a Total number of persons covered by the plan who are highly compensated individuals(See instructions below.) . . 73 b Number of other employees covered by the plan 259 c Number of employees not covered by the plan 192 d Total number employed* 451 *Should equal the total of a,b,and c—if not,explain any difference.Describe the eligibility requirements that prevent those employees not covered by the plan from participating. 4 State the number of persons, if any, other than employees and their dependents (for example, the proprietor of a business whose employees are members of the association)who are entitled to receive benefits ► 0 Instructions Line 3a.—A"highly compensated individual" is one who: (b) Received more than$80,000(adjusted for inflation) in compensation from the employer for the preceding (a) Owned 5% or more of the employer at any time year, and during the current year or the preceding year, (c) Was among the top 20% of employees by compensation for the preceding year. However, the employer can choose not to have(c) apply. Form 1024(Rev.1-2018)