2024-02-02T13:02:57-06:00 2023-06-30 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2022-07-01 954704003 City of Burbank Welfare Benefit Plan Tr CITY 5095340600 PO Box 5433 Spokane WA 992050423 Steven R Sherman Trustee Representative 5093534106 2024-01-25 1 Steven Sherman 999009999 1 SCOTT OPPERUD CPA P00542597 5097472158 2024-01-25 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Steven R Sherman PO Box 2127 Spokane WA 99210 1729772 0 X N/A X 1997 CA To provide qualified health and welfare benefits through a health reimbursement arrangement (HRA). 1 0 0 0 0 0 0 0 435074 657878 210052 112637 0 0 645126 770515 0 0 505888 511693 0 0 0 0 0 69950 62962 575838 574655 69288 195860 10079312 11400316 15117 5550 10064195 11394766 To provide participants and their dependents with medical benefits not provided by Social Security, Medicare, Medicaid, or any other medical insurance contract or plan. 0 0 This trust holds the assets of the City of Burbank Welfare Benefit Plan (the Plan). The Plan was established on November 25, 1997. The Plan is a defined contribution, health and welfare benefit plan commonly referred to as a "health reimbursement arrangement" plan. The Plan is designed to be a tax-free account for participants to pay medical benefits not provided by Social Security, Medicare, or any other medical insurance contract or plan. The payments or reimbursements may not be made for items paid or payable by any other insurance contract or plan, or for expenses that are deducted by the participant under any Section of the Internal Revenue Code. The aforementioned expenses must be expenses of the participants, the spouses of the participants and/or the dependents of the participants. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 1 0 0 0 X Arthur J Gallagher & Co 5098385571 221 N Wall Street Suite 201 Spokane WA 99201 Washington Trust Bank Trustee 2.00 X 12457 0 0 12457 0 0 0 0 0 0 0 Plan contributions 525100 657878 657878 657878 195807 195807 876087 959257 -83170 -83170 -83170 770515 657878 0 112637 511693 10341 9100 12457 29112 1952 574655 115 89 24989 26411 10054208 11373816 10079312 11400316 15117 5550 15117 5550 X 10064195 11394766 10064195 11394766 10079312 11400316 195860 1134711 0 X 0 1 X 0 0 0 1905226 1134711 1134711 770515 0 770515 574655 0 574655 0 574655 Form 990, Part VI, Section A, line 7a The Trust holds the assets of the City of Burbank Welfare Benefit Plan (the Plan). The corporate trustee executes certain directives of the administrator, which is the City of Burbank, California (the City). The City may replace the corporate trustee at any time. Form 990, Part VI, Section A, line 7b The Trust holds the assets of the City of Burbank Welfare Benefit Plan (the Plan). The corporate trustee executes certain directives of the administrator, which is the City of Burbank, California (the City). The City retains responsibility for the oversight and administration of the Plan and Trust. Form 990, Part VI, Section A, line 8a The Trust holds the assets of the City of Burbank Welfare Benefit Plan (the Plan). The corporate trustee executes certain directives of the administrator, which is the City of Burbank, California. No trustee meetings are held; however, all directives and communications between the trustee and administrator are documented and retained. In addition, any changes in the administration of the Plan, changes in the policies or procedures of the Plan, and all amendments to the Plan, are communicated in writing to all participants. Form 990, Part VI, Section A, line 8b The Trust does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 was prepared under the guidance of the Plan Administrator (City of Burbank, California) by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC. Draft copies of the Trust's financial statements and Form 990 were first provided to the Trust's consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the consultants and advisors were addressed and any necessary revisions were made to the Form 990. The revised Form 990 was then provided to the authorized representatives of the City of Burbank, California for their review and approval. Any additional questions, concerns or issues raised by the City of Burbank, California were addressed, and any necessary revisions were made to the Form 990. The final version of the Form 990 was provided to the corporate trustee for final review and approval to file. Form 990, Part VI, Section B, line 12a: The conflict-of-interest policy of the City of Burbank, California is available to the public upon written request by contacting the City of Burbank, California at 301 E Olive Avenue, Suite 100; Burbank, CA 91502. Form 990, Part VI, Section C, line 19 The Trust's governing documents, whistleblower policy, document retention and destruction policy, and financial statements are available to the public upon written request by contacting the Trust at: PO Box 5433; Spokane, WA 99205. The Trust itself does not have a conflict-of-interest policy. However, the City of Burbank, California, the administrator, has a conflict-of-interest policy, which is available to the public upon written request by contacting the City of Burbank at: 301 E Olive Avenue, Suite 100; Burbank, CA 91502. City of Burbank 301 E Olive Avenue Suite 100 Burbank CA 91502 956000683 Local government responsible for the City of Burbank, CA CA N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1