Form Rp-420-A/b-Org - Application For Real Property Tax Exemption For Nonprofit Organizations Page 7

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SCHEDULE A
7
RP-420-a/b-Org (1/95)
Part C – Finances (continued)
b. Does the organization have any arrangements to provide insurance for members, their dependents, or others (including provisions for the
payment of sick or death benefits and pensions and annuities)?
___________Yes ____________No
If yes, please describe and explain the arrangement’s rules of eligibility.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
c. Officers, directors and trustees:
Time
Contributions to
Expense account and
Name and title
devoted to
Compensation
Employee Benefit Plans
other Allowances
position
(annual)
(annual)
(annual)
d. Five highest paid full-time employee (other than officers, directors and trustees):
Time
Contributions to
Expense account and
Name, and Title and Address
devoted to
Compensation
Employee Benefit Plans
other Allowances
Position
(annual)
(annual)
(annual)
3e. Five highest paid part-time employees (other than officers, directors and trustees):
Time
Contributions to
Expense Account and
devoted to
Compensation
Employee Benefit Plans
other Allowances
Name, title and Addresses
position
(annual)
(annual)
(annual)

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