PDF-Form Department of the Treasury Internal Revenue Service Alternative Motor Vehi

Information about Form 8910 and its separate instructions is at wwwirsgovform8910 OMB No 15451998 20 13 Attachment Sequence No 152 Names shown on return Identifying number Note Use this form to claim the credit for certain alternative motor vehicle. Attach to Form 990 or Form 990EZ Information about Schedule L Form 990 or 990EZ and its instructions is at wwwirsgovform990 OMB No 15450047 20 14 Open To Public Inspection Name of the organization Employer identification number Part I Excess Benefit Attach to Form 990 Information about Schedule R Form 990 and its instructions is at wwwirsgovform990 OMB No 15450047 20 14 Open to Public Inspection Name of the organization Employer identification number Part I Identification of Disregarded Entitie Information about Form 8917 and its instructions is at wwwirsgovform8917 OMB No 15450074 20 13 Attachment Sequence No 60 Names shown on return Your social security number CAUTION You cannot take both an education credit from Form 8863 and the tuitio Information about Form 8863 and its separate instructions is at wwwirsgovform8863 OMB No 15450074 20 14 Attachment Sequence No 50 Names shown on return Your social security number CAUTION Complete a separate Part III on page 2 for each student for w Information about Schedule D Form 1120 and its separate instructions is at wwwirsgovform1120 OMB No 15450123 20 14 Name Employer identification number Part I ShortTerm Capital Gains and LossesAssets Held One Year or Less See instructions for how to Information about Schedule J and its separate instructions is at wwwirsgovschedulej OMB No 15450074 20 14 Attachment Sequence No 20 Names shown on return Social security number SSN 1 Enter the taxable income from your 2014 Form 1040 line 43 or Form Attach to Form 990 or Form 990EZ Information about Schedule L Form 990 or 990EZ and its instructions is at wwwirsgovform990 OMB No 15450047 20 14 Open To Public Inspection Name of the organization Employer identification number Part I Excess Benefit Attach to Form 990 or 990EZ Information about Schedule O Form 990 or 990EZ and its instructions is at wwwirsgovform990 OMB No 15450047 20 14 Open to Public Inspection Name of the organization Employer identification number For Paperwork Reduction Ac Form 23 (October 2020) See Instructions on Page 3 OMB Number 1545-0950Before you file this form, you must: • Take and pass all three parts of the Special Enrollment Examination Check here if y . VEHI Monthly Health Plan Rates FY 21 in effect July 1, 2020 – June 30, 2021 SingleSelf + SpouseParent + Platinum $821.38 $1,642.76 $1,373.47 $2,323.67 13.7% Gold $790.20 $1,58 0 .39 Barre School Board Presentations May, 2017 Our Current Plan Benefits and Out of Pocket Costs Our Current Plan Premium and Cost Share Annual Premium Cost and Cost Share for FY17 VEHI VHP Plan Tier VE tActive employees will benefit tThe Vermont State Teachers Retirement System will benefit 1 Commitment of VEHI tPerformance Measures 1 This is only a summaryIf you want more detail about youcoverage and costscan get the complete terms in the policy or plan document at vehiorgor by calling insertImportant QuestionsAnswersWhy this Matt Do not sign this form unless all applicable lines have been completed Request may be rejected if the form is incomplete or illegible For more information about Form 4506 visit wwwirsgov/form4506OM