Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 20
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Form 1024 (Rev. 9-98)
Page
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.
2
Are any employees or classes of employees entitled to benefits to which other employees or classes of employees are
not entitled?
Yes
No
If “Yes,” explain.
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
(mo.) (day) (yr.)
a
Total number of persons covered by the plan who are highly compensated individuals (See instructions below.)
b
Number of other employees covered by the plan
c
Number of employees not covered by the plan
*
d
Total number employed
* 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 (e.g., the proprietor of a business whose
employees are members of the association) who are entitled to receive benefits
Instructions
Line 3a.—A “highly compensated individual” is one
(b) Received more than $80,000 (adjusted for
who:
inflation) in compensation from the employer for the
preceding year, and
(a) Owned 5% or more of the employer at any time
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.
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