2025-11-14T18:05:03-06:00 2024-12-31 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2024-01-01 566626298 State of Indiana Health Reimbursement Arrangement HRA Account Plan Trust STAT 5098385571 221 N Wall Street 201 Spokane WA 99201 Steven R Sherman Trustee Representative 5093534106 2025-11-14 1 1 SCOTT OPPERUD CPA P00542597 5097472158 2025-11-05 2024 2025-03-06 01:10:19Z Steven R Sherman 221 N Wall Street 201 Spokane WA 99201 38659237 0 X IndianaHRA.com X 2003 WA To provide qualified health and welfare benefits through a health reimbursement arrangement (HRA). 1 0 0 0 0 0 0 0 6229099 7867840 12489370 18620001 0 0 18718469 26487841 0 0 16638156 16859032 0 0 0 0 0 1656385 1780933 18294541 18639965 423928 7847876 321245258 342634381 345931 508727 320899327 342125654 X The Trust has been established to provide employees with health benefits as set forth in the related plan, while they are eligible to receive such benefits, and to provide such other permissible payments as may be determined from time to time. It is intended that the benefits and payments provided by the related plan and funded through the Trust be "life, sick, accident, or other benefits" as that phrase is defined in Section 501(c)(9) of the Internal Revenue Code. 0 0 This trust holds the assets of the State of Indiana Health Reimbursement Arrangement "HRA" Account Plan (the Plan) for employees of school corporations and governmental employers within the State of Indiana. 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 health benefits not provided by Social Security, Medicare, or any other health 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 or which were incurred prior to becoming a participant of the Plan. Reimbursement may be made for the out-of-pocket portion of premiums due for Medicare. The aforementioned expenses must be expenses of the participants, the spouses of the participants and/or the tax-qualified 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 1 0 0 0 1 1 0 1 0 0 1 1 1 1 1 1 0 0 0 X HRA Administrator LLC 5098385571 221 N Wall Street Suite 201 Spokane WA 99201 Washington Trust Bank Trustee 2.00 X 0 108603 0 0 108603 0 0 0 0 0 HRA Administrator LLC 221 N Wall Street Suite 201 Spokane WA 99201 Plan administration 1744443 1 Plan contributions 525100 7867840 7867840 7867840 17017757 17017757 13773640 12171396 1602244 1602244 1602244 26487841 7867840 0 18620001 16859032 1744443 PCORI Fees 36490 18639965 279354 417987 215472103 234565549 105493801 107650845 321245258 342634381 139824 162993 139530 254994 66577 90740 345931 508727 X 320899327 342125654 320899327 342125654 321245258 342634381 7847876 13378451 0 X 0 1 X 0 0 0 Group Insurance Annuity Contracts 107650845 C 107650845 Benefits payable 90740 90740 39866292 13378451 13378451 26487841 0 26487841 18639965 0 18639965 0 18639965 Form 990, Part VI, Section A, line 3 Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have delegated management responsibility over the administration and oversight of the Plan and Trust to the Sponsor and Administrator (HRA Administrator, LLC) and to the corporate trustee (Washington Trust Bank). Pursuant to the Trust Agreement and a trust services agreement between the corporate trustee and the Administrator (on behalf of the Plan), the corporate trustee executes certain directives of the Sponsor and Administrator of the Plan and provides basic investment management services. The Trust has established a Conflicts Committee and an Ethics Committee with the authority to act on behalf of the governing body. To ensure the Trust operates in a manner consistent with its tax-exempt purposes and does not engage in activities that could jeopardize its tax-exempt status, the committees conduct periodic reviews. The periodic reviews include, at a minimum, the following subjects: Whether the contractual arrangements with service providers and the services provided are reasonable, based on competent market and survey information, and the result of arm's length negotiation. Whether contractual arrangements with service providers and arrangements with other organizations conform to written policies, are properly recorded, reflect reasonable investment or payments for goods and services, further tax-exempt purposes, and do not result in inurement, impermissible private benefit or in an excess benefit transaction. Whether any transaction conducted by the Trust during the review period involves or could possibly give rise to a conflict of interest. Form 990, Part VI, Section A, line 7a Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have delegated management responsibility over the administration and oversight of the Plan and Trust to the Sponsor and Administrator (HRA Administrator, LLC) and to the corporate trustee (Washington Trust Bank). Pursuant to the Trust Agreement and a trust services agreement between the corporate trustee and the Administrator (on behalf of the Plan), the corporate trustee executes certain directives of the Sponsor and Administrator of the Plan and provides basic investment management services. The Adoption Agreement executed by each adopting employer identifies one Employee Representative (one voting member) for each employee group. Each Employee Representative is independent. The Employee Representatives have the authority to act on behalf of the membership with respect to the removal and replacement of the Trustee and Sponsor. Pursuant to the Plan and Trust Agreement, a majority of Employee Representatives, acting on behalf of the participants of the Plan, have the authority to remove the corporate trustee and/or veto the removal or appointment of any replacement trustee by the Sponsor, and to veto the recommendation of a replacement Sponsor should a vacancy occur in the Sponsor of the Plan. Form 990, Part VI, Section A, line 7b Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have delegated management responsibility over the administration and oversight of the Plan and Trust to the Sponsor and Administrator (HRA Administrator, LLC) and to the corporate trustee (Washington Trust Bank). Pursuant to the Trust Agreement and a trust services agreement between the corporate trustee and the Administrator (on behalf of the Plan), the corporate trustee executes certain directives of the Sponsor and Administrator of the Plan and provides basic investment management services. The Adoption Agreement executed by each adopting employer identifies one Employee Representative (one voting member) for each employee group. Each Employee Representative is independent. The Employee Representatives have the authority to act on behalf of the membership with respect to the removal and replacement of the Trustee and Sponsor. Pursuant to the Plan and Trust Agreement, a majority of Employee Representatives, acting on behalf of the participants of the Plan, have the authority to remove the corporate trustee and/or veto the removal or appointment of any replacement trustee by the Sponsor, and to veto the recommendation of a replacement Sponsor should a vacancy occur in the Sponsor of the Plan. Form 990, Part VI, Section A, line 8a The Trust holds the assets of the State of Indiana Health Reimbursement Arrangement "HRA" Account Plan (the Plan) for employees of school corporations and governmental employers within the State of Indiana. Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have delegated management responsibility over the administration and oversight of the Plan and Trust to the Sponsor and Administrator (HRA Administrator, LLC) and to the corporate trustee (Washington Trust Bank). Pursuant to the Trust Agreement and a trust services agreement between the corporate trustee and the Administrator (on behalf of the Plan), the corporate trustee executes certain directives of the Sponsor and Administrator of the Plan and provides basic investment management services. 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 participating employers and employee/members. Form 990, Part VI, Section B, line 11b The Form 990 was prepared under the guidance of the Plan Administrator (HRA Administrator, LLC) 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 Plan Administrator, consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the Plan Administrator, consultants and advisors 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 12c In addition to the delegation of management and oversight to the Trustee and the Sponsor/Administrator, as described in the explanation for Part VI, Section A, line 1 of Form 990, the Trust has established a Conflicts Policy and a Conflicts Committee. An interested party is under a continuing obligation to disclose any potential conflict of interest to the Conflicts Committee as soon as it is known or reasonably should be known. In addition, if any member of the Conflicts Committee has reasonable cause to believe an individual has failed to disclose an actual or possible conflict of interest, they will inform the interested person of the basis for such belief and afford the interested person an opportunity to explain the alleged failure to disclose. In summary, the interested person is given the opportunity to disclose all material facts to the Conflicts Committee when considering the proposed transaction or arrangement. Based on all material facts, the Conflicts Committee conducts a hearing to determine if a conflict of interest exists and what, if any, actions are required to eliminate or mitigate the conflict of interest. To ensure the Trust operates in a manner consistent with its tax-exempt purposes and does not engage in activities that could jeopardize its tax-exempt status, the Conflicts Committee conducts periodic reviews. The periodic reviews include, at a minimum, the following subjects: Whether the contractual arrangements with service providers and the services provided are reasonable, based on competent market and survey information, and the result of arm's length negotiation. Whether contractual arrangements with service providers and arrangements with other organizations conform to written policies, are properly recorded, reflect reasonable investment or payments for goods and services, further tax-exempt purposes, and do not result in inurement, impermissible private benefit or in an excess benefit transaction. Whether any transaction conducted by the Trust during the review period involves or could possibly give rise to a conflict of interest. Form 990, Part VI, Section B, Line 15: The governance structure of the Plan and Trust does not include a CEO, Executive Director, top management official, or other key employee. However, the Conflicts Committee periodically reviews all contractual arrangements with service providers to the Plan and Trust to determine whether compensation and services provided are reasonable based upon competent market and survey information. Form 990, Part VI, Section C, line 19 The Trust's governing documents, conflict of interest policy, other policies and procedures, and financial statements are available to all adopting employers and employee/participants of the Plan upon written request by contacting the Trust at 221 N Wall Street, Suite 201; Spokane, WA 99201. Form 990, Part VI, Section A, line 1: Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have established the Plan and Trust in order to provide benefits and payments consisting of "life, sick, accident, or other welfare benefits", as that phrase is defined by Section 501(c)(9) of the Internal Revenue Code. Pursuant to the Plan and the Trust Agreement, participation in the Plan and Trust consists of individuals (i) who become entitled to participate by reason of current or former employment with one of the adopting employers, (ii) for whom a contribution has been made by the employer, (iii) who have otherwise also met all eligibility requirements, and (iv) who have negotiated for the right to participate in the plan pursuant to a collective bargaining agreement. Pursuant to the Plan and Trust Agreement, the employers who have adopted the Plan and become settlors of the Trust have delegated management responsibility over the administration and oversight of the Plan and Trust to the Sponsor and Administrator (HRA Administrator, LLC) and to the corporate trustee (Washington Trust Bank). Pursuant to the Trust Agreement and a trust services agreement between the corporate trustee and the Administrator (on behalf of the Plan), the corporate trustee executes certain directives of the Sponsor and Administrator of the Plan and provides basic investment management services. The Adoption Agreement executed by each adopting employer identifies one Employee Representative (one voting member) for each employee group. Each Employee Representative is independent. The Employee Representatives have the authority to act on behalf of the membership with respect to the removal and replacement of the Trustee and Sponsor. Pursuant to the Plan and Trust Agreement, a majority of Employee Representatives, acting on behalf of the participants of the Plan, have the authority to remove the corporate trustee and/or veto the removal or appointment of any replacement trustee by the Sponsor, and to veto the recommendation of a replacement Sponsor should a vacancy occur in the Sponsor of the Plan. Part VI, Section A, line 6: Pursuant to the Plan and Trust Agreement, the Employers who have adopted the Plan and become settlors of the Trust have established the Plan and Trust in order to provide benefits and payments consisting of "life, sick, accident, or other welfare benefits", as that phrase is defined by Section 501(c)(9) of the Internal Revenue Code. Pursuant to the Plan and the Trust Agreement, membership in the Plan and Trust consists of individuals (i) who become entitled to participate by reason of current or former employment with one of the adopting employers, (ii) for whom a contribution has been made by the employer, (iii) who have otherwise also met all eligibility requirements, and (iv) who have negotiated for the right to participate in the plan pursuant to a collective bargaining agreement. 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