2024-11-15T15:27:58-06:00 2023-12-31 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2023-01-01 912156027 City of Santa Clara VEBA Postretirement Medical Reimbursement Account Plan Trust CITY 5098385571 221 N Wall Street 201 Spokane WA 99201 Steven R Sherman Trustee Representative 5093534106 2024-11-13 1 1 SCOTT OPPERUD CPA P00542597 5097472158 2024-11-13 2023 2024-10-15 13:58:12Z Steven R Sherman PO Box 2127 Spokane WA 99210 5827062 0 X N/A X 2001 CA To provide qualified health and welfare benefits through a health reimbursement arrangement (HRA). 1 0 0 0 0 0 0 0 2194589 1958377 0 3868685 0 0 2194589 5827062 0 0 2022061 2059018 0 0 0 0 0 6190193 90847 8212254 2149865 -6017665 3677197 34148874 37639927 209563 23419 33939311 37616508 X To provide participants and their dependents with post-retirement medical benefits not provided by Medicare or any other medical insurance contract or plan. 0 0 This trust holds the assets of the City of Santa Clara Voluntary Employees' Beneficiary Association Postretirement Medical Reimbursement Account Plan (the Plan). The Plan was established on October 15, 2001, and has most recently been amended and restated effective January 1, 2017. 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 post-retirement medical benefits not provided by 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 1 0 0 1 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 0 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 0 0 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 0 14448 0 0 14448 0 0 0 0 0 0 Plan contributions 525100 1958377 1958377 1958377 3868685 3868685 5827062 1958377 0 3868685 2059018 90847 2149865 198073 0 33950801 37639927 34148874 37639927 209563 23419 209563 23419 X 33939311 37616508 33939311 37616508 34148874 37639927 3677197 0 X 0 1 X 0 0 0 Investment in HealthInvest Master Trust 37639927 F 37639927 Benefits payable 23419 23419 5827062 0 5827062 0 5827062 2149865 0 2149865 0 2149865 Form 990, Part VI, Section A, line 7a The Trust holds the assets of the City of Santa Clara Voluntary Employees' Beneficiary Association Postretirement Medical Reimbursement Account Plan (the Plan). The corporate trustee executes certain directives of the administrator which is the City of Santa Clara, 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 Santa Clara Voluntary Employees' Beneficiary Association Postretirement Medical Reimbursement Account Plan (the Plan). The corporate trustee executes certain directives of the administrator which is the City of Santa Clara, California (the City). The City retains responsibility for the oversight and administration of the Plan. Form 990, Part VI, Section A, line 8a The Trust holds the assets of the City of Santa Clara Voluntary Employees' Beneficiary Association Postretirement Medical Reimbursement Account Plan (the Plan). The corporate trustee executes certain directives of the administrator which is the City of Santa Clara. No trustee meetings are held; however, all directives and communications between the trustee and plan sponsor are documented and retained. In addition, any changes in the administration of the Plan, or in 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 Santa Clara, 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 Santa Clara, California for their review and approval. Any additional questions, concerns or issues raised by the City of Santa Clara, 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 Trust itself does not have a conflict of interest policy. However, the City of Santa Clara, California, has this policy, which is available to the public upon written request by contacting the City of Santa Clara at 1500 Warburton Avenue; Santa Clara, CA 95050. Form 990, Part VI, Section C, line 19 The Trust's governing documents and financial statements are available to the public upon written request by contacting the Trust at: 221 N Wall Street, Suite 201; Spokane, WA 99201. The Trust itself does not have conflict of interest or whistleblower policies. However, the City of Santa Clara, California, the Trust sponsor, has these policies, which are available to the public upon written request by contacting the City of Santa Clara at 1500 Warburton Avenue; Santa Clara, CA 95050. City of Santa Clara 1500 Warburton Avenue Santa Clara CA 95050 946000426 Local government responsible for the City of Santa Clara, CA CA N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1