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Firefighters Relief Association Reporting Form <br />Year Ended December 31, 1991 <br />BYLAWS REPORT <br />TYPE AND AMOUNT OF OTHER BENEFITS <br />1. Sick: ❑ Lump Sum ❑ Weekly ❑ Monthly ❑ Year of Service <br />2. Disability: 3 Lump Sum • Weekly • Monthly ❑ Year ofService <br />3. Funeral: El Lump Sum ❑ Year of Service • Other <br />(enter N/A <br />1 $ <br />2 $ <br />3 $ <br />AMOUNT <br />if not N applicable) <br />/ A <br />2,00U <br />2,000 <br />4. Accident and Health Insurance (Volunteer Firemans Benefit <br />Association or other) <br />4 <br />❑ Yes 8 No <br />MINIMUM REQUIREMENTS FOR SERVICE PENSION <br />5. Minimum Retirement Age <br />5 <br />50 <br />6. Minimum Years as an Active Member of Fire Department <br />6 <br />10 <br />7. Minimum Years as an Active Member of Relief Association <br />7 <br />10 <br />. COMPLETE SECTION WHICH APPLIES <br />(Lump Sum, Monthly Annuity, or Defined Contribution) <br />LUMP SUM PENSION BENEFITS (or lump sum paid in installments) <br />Requirements for full vesting <br />8. Number of Years of Service <br />8 <br />20 <br />9. Amount per Year of Service <br />9 <br />$ <br />2,Oflf <br />10. Do Bylaws Provide for Early Vesting? <br />10 <br />ia Yes • No <br />Benefit payable for each year of service <br />(check one) <br />11. $1.00 or more but less than $50.00 <br />11 <br />12. $50.00 or more but less than $100.00 <br />12 <br />13. $100.00 or more but less than $200.00 <br />13 <br />14. $200.00 or more but less than $300.00 <br />14 <br />15. $300.00 or more but less than $600.00 <br />15 <br />16. $600.00 or more but less than $1,000.00 <br />16 <br />17. $1,000.00 or more but less than $2,000.00 <br />17 <br />18. $2,000.00 or more <br />18 <br />2 000 <br />MONTHLY ANNUITY PENSION BENEFIT <br />19. Date of Most Recent Actuarial Valuation <br />19 <br />20. Date Filed with State Auditor * <br />20 <br />Requirements for full vesting <br />21. Number of Years of Service <br />21 <br />22. Amount per Month per Year of Service <br />22 <br />$ <br />23. Do Bylaws Provide for Early Vesting? <br />23 <br />❑ Yes ❑ No <br />Benefit payable for each month of service <br />(check one) <br />24. Less than $2.00 <br />24 <br />25. $2.00 or more but less than $4.00 <br />25 <br />26. $4.00 or more <br />26 <br />27. Benefits after 20 years (amount per month of service) <br />27 <br />$ <br />DEFINED CONTRIBUTION (split- the -pie) <br />28. Please submit a schedule of total assets accrued to each member's account and current <br />year's calculation. Attach schedule. <br />28 <br />❑ Yes ❑ No <br />NOTE: <br />*All relief associations associated with a volunteer fire department and paying a monthly annuity <br />must submit an actuarial survey every four years by July 1 of the year following the date of which <br />the survey is prepared to the parties listed below. All relief associations associated with a salaried <br />(career) fire department must submit an actuarial survey annually by July 1 to the parties listed below. <br />a) State Auditor <br />b) Your Municipality <br />c) Legislative Commission on Pensions and Retirement <br />d) Legislative Reference Library <br />Page 57 <br />2 <br />