Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 14
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2014
Form 1024 (Rev. 1-2018)
Page
Schedule F
Organizations described in section 501(c)(9) (Voluntary employees’ beneficiary associations)
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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.
Are any employees or classes of employees entitled to benefits to which other employees or classes of employees are
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not entitled?
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Yes
No
If “Yes,” explain.
Give the following information for each plan as of the last day of the most recent plan year and enter that date here. If
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there is more than one plan, attach a separate schedule
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(mo.) (day)
(yr.)
a
Total number of persons covered by the plan who are highly compensated individuals (See instructions below.) .
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b
Number of other employees covered by the plan .
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c
Number of employees not covered by the plan
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d
Total number employed* .
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* 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.
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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
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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.
1024
Form
(Rev. 1-2018)
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