IBEW/ Verizon

New England Work and Family Committee

Summer Camp Program

Taxable Reimbursement Program

June 13- August 28, 2010

 

 

 

 

 

 

                                 

 

Overnight Camp and Day Camp 

Summer Program 

 

 

 

 

 

 

 

 

 

 

IBEW/ Verizon

New England Work and Family Committee

Summer Camp Program

Taxable Reimbursement Program

 

The New England Work and Family Committee understands the difficulties families face when school is out for the summer.   We want to ease your financial obligation this summer and reimburse for summer camp/ day camp programs.      

 

The summer camp program runs from June 13 through August 28, 2010.  This program was created to enrich your school age (ages 5-17) child’s summer experience.  The New England Work and Family Committee will reimburse up to $200.00 per week for a maximum of 4 weeks for the period identified above.  We will reimburse for overnight summer camps, day camps and summer programs. Your dependent can enjoy the outdoors, learn a skill, or participate in an athletic camp.  The summer camp program is not daycare.  All summer camp reimbursements from this program are taxable.

 

     

Eligibility Requirements

 

·               You must be a member of IBEW, management or non-bargained from MA and  RI , VT , NH ME

·               CWA and IBEW 2213, VIS, Idearc and FairPoint employees  are not eligible for this program

·               You must have a total household income less than $125,000 for year 2009

·               The program is for your dependents  ages 5-17 listed on your tax return

·               You must have incurred overnight camp or day camp expenses.

 

 

Camp Eligibility

 

Camp must be an overnight or day camp summer program that has a tax identification number. 

Some camps that are included in the program are:  adventure camps, arts camps, sports camps and traditional outdoor camps such as YMCA, 4H or Boys/Girls Club.

We do not reimburse for international camps, college prep programs, college courses, school, lessons, tutoring, registration fees, memberships, transportation fee, field trips, supplies, T shirts and daycare.

 

Family daycare, in home daycare, or programs normally covered by the Dependent Care Reimbursement Program are ineligible for The Summer Camp Reimbursement Program.  You may be eligible for the Dependent Care Reimbursement Program (DCRF). 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How do I apply?

 

You can obtain an application by going to www.verizon.com/life and click on union member resources, select New England Work and Family. You can call 508-890-3558 or call your union representative.   

·               Complete the application in its entirety

·               Complete and application for each dependent

If you have enrolled in more than one summer camp program, complete an application for each camp.

           

·               Have summer camp director/ administrative office sign the application after the camp session is completed.

·               Applications must have original signatures

·               Attach receipts and canceled checks where applicable  to the application (receipt should  include: camp name, child’s name, dates of camp and  cost of camp)

·                Please include a flyer, brochure or advertisement of  the camp program

·               Send your 2009 1040 federal tax return if you are married and  file separately please include spouses 1040 (dependents name must be on employees tax return)

·               If your child’s name is not on your tax return because of a recent adoption, please attach documentation.

·               Send 2009 employee W2 (must be a Verizon employee). 

·               You submit the application after all camp(s)  have been attended (please send  all forms for all camps  in 1 envelope)

 

How much am I reimbursed?

 

You may be reimbursed up to $200 per week for a maximum of 4 weeks during the summer from June 13 through August 28, 2010.

 

Complete the application and return along with your 2009 federal tax return, W2 and receipts for summer camp. The application must be postmarked no later than September 30, 2010. Your reimbursement will be included your paycheck.

 

You can not claim reimbursement for both The Dependent Care Reimbursement Fund DCRF and the Summer Camp Program for the same week.

  

Liability Statement

The employee assumes all responsibility for determining the quality and capability of a care provider, and assumes all responsibility for choosing a provider.  I understand that VERIZON and IBEW do not hire, train or supervise child or camp providers, nor do they screen, endorse, or recommend any provider of care, nor represent or guarantee that the provider the employee has chosen will provide quality care.  VERIZON and IBEW are neither responsible nor liable for any injuries or damages of any nature suffered as result of the acts or omission of a provider of care in the operation of its business.

 

VERIZON and IBEW retain the right to change the eligibility requirements or amount of reimbursement as well as any other provision of the Summer Camp Taxable program.

 

Eligibility for reimbursement terminates upon my termination of employment with Verizon

 

This is a Taxable Summer Camp Reimbursement Program

IBEW/Verizon New England Work and Family Committee

2010 Summer Camp Taxable Reimbursement Program

Complete ALL information. Your application WILL BE RETURNED if any information is missing. Please print clearly or type.

Employee Name                                             Social Security #
Home Address
City State Zip Code
Home Phone
Work Address
City                                                            State                             Zip Code
Work Phone                                                                       Cell Phone
Email		Marital status     Single      Married
Circle and fill in local   IBEW Local _____________ Management             Non Bargained
Do you participate in the Dependent Care Reimbursement Program?  NO  YES        If yes please name your dependents in the program (You can not claim reimbursement for both DCRF and Summer Camp)
We do not reimburse for international camps, school, college prep programs, college courses, lessons, tutoring, registration fees, memberships, transportation fee, field trips, supplies, T shirts and daycare.
1) Dependent Full Name                                         DOB                              Age
Type of Summer Camp Reimbursement Request      Summer Day Camp      Summer Camp Over Night
Camp Name
Tax ID Number
Camp Provider’s Address
Camp Provider’s Phone Number
Indicate which week(s) and the cost for each week
JUNE	JULY		AUGUST
6/13- 6/19 $	6/27-7/3  $		8/1- 8/7 $
6/20-6/26 $	7/4-7/10  $		8/8- 8/14 $
	7/11- 7/17 $		8/15- 8/21 $
	7/18- 7/24 $		8/22- 8/28 $
	7/25- 7/31  $
Total for all weeks $
Camp Director/Administrative Office Original Signature                   Date

You MUST attach a copy of your 1040 and W2 for year 2009, receipts and advertisement from camp before sending. Only original applications and signatures submitted with 1040, detailed receipts and cancelled checks will be reimbursed.

Employee Authorization:

I, (Print Name) ________________________________________ am requesting reimbursement for the expenses listed above. I have read the criteria of the 2010 Summer Camp Program and agree to abide by them and my signature signifies I abided by the criteria By signing and submitting application, I am certifying the information that I have provided on this form(s) to be true and accurate. I further understand that supplying false information may jeopardize my participation in the Work & Family Fund

Employee Signature                                                                                                     Date

Send this form and attachments to:

Verizon/ IBEW Attn:  New England Work & Family

15 Chestnut St. Floor 3

Worcester, MA 01609

Post marked No later than September 30, 2010