Employment Eligibility Verification USCIS

Form I-9
Department of Homeland Security OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 03/31/2016

START HERE. Read instructions carefully before completing this form. The instructions must be available during completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which
document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future
expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name) First Name (Given Name) Middle Initial Other Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State Zip Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number E-mail Address Telephone Number

- -
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following):
A citizen of the United States
A noncitizen national of the United States (See instructions)

A lawful permanent resident (Alien Registration Number/USCIS Number):

An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy) . Some aliens may write "N/A" in this field.
(See instructions)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:
1. Alien Registration Number/USCIS Number:
3-D Barcode
OR Do Not Write in This Space
2. Form I-94 Admission Number:

If you obtained your admission number from CBP in connection with your arrival in the United
States, include the following:

Foreign Passport Number:

Country of Issuance:
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions)

Signature of Employee: Date (mm/dd/yyyy):

Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the
employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the
information is true and correct.

Signature of Preparer or Translator: Date (mm/dd/yyyy):

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State Zip Code

Employer Completes Next Page

Form I-9 03/08/13 N Page 7 of 9

Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR examine a combination of one document from List B and one document from List C as listed on
the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title,
issuing authority, document number, and expiration date, if any.)

Employee Last Name, First Name and Middle Initial from Section 1:

List A OR List B AND List C

Identity and Employment Authorization Identity Employment Authorization
Document Title: Document Title: Document Title:

Issuing Authority: Issuing Authority: Issuing Authority:

Document Number: Document Number: Document Number:

Expiration Date (if any)(mm/dd/yyyy): Expiration Date (if any)(mm/dd/yyyy): Expiration Date (if any)(mm/dd/yyyy):

Document Title:

Issuing Authority:

Document Number:

Expiration Date (if any)(mm/dd/yyyy):

3-D Barcode
Document Title: Do Not Write in This Space

Issuing Authority:

Document Number:

Expiration Date (if any)(mm/dd/yyyy):

Certification
I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the
above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions.)
Signature of Employer or Authorized Representative Date (mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name (Family Name) First Name (Given Name) Employer's Business or Organization Name

Grand Teton Lodge Company

Employers buisness or organization address (street number and name) City or Town State Zip Code

Hyw 89 5 Miles North of Moran Moran WY 83013

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial B. Date of Rehire (if applicable) (mm/dd/yyyy):

C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee
presented that establishes current employment authorization in the space provided below.
Document Title: Document Number: Expiration Date (if any)(mm/dd/yyyy):

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative: Date (mm/dd/yyyy): Print Name of Employer or Authorized Representative:

Form I-9 03/08/13 N Page 8 of 9

 POST-OFFER INVITATION TO APPLICANTS TO SELF IDENTIFY
AS A PROTECTED VETERAN

Vail Resorts is a federal contractor subject to the Vietnam Era Veterans’

Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C.
4212 (“VEVRAA”), which requires contractors to take affirmative action to employ and advance in
employment disabled veterans, recently separated veterans, active duty wartime or campaign badge
veterans, and Armed Forces service medal veterans.

As a federal contractor, we are required to submit a report to the U.S. Department of

Labor each year identifying the number of our employees belonging to each “protected veteran”
category. This information is being requested on a voluntary basis and will be kept confidential as
required by law. Refusal to provide the requested information will not subject you to adverse
treatment. If provided, this information will not be used in a manner inconsistent with VEVRAA.

Name: ___________________________________________ Date: _______________

Last First Middle Initial

If you believe you belong to any of the categories of protected veterans listed below, please indicate
by checking the appropriate box(es) below.

☐ I AM A DISABLED VETERAN
I qualify as a Disabled Veteran because I am: (a) a veteran of the U.S. military, ground, naval or air
service who is entitled to compensation (or who but for the receipt of military retired pay would be
entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (b) a
person who is discharged or released from active duty because of a service-connected disability.

☐ I AM A RECENTLY SEPARATED VETERAN

I qualify as a recently separated veteran because I was discharged or released from active duty in the
U.S. military, ground, naval, or air service within the last three years.
Date of Separation: ________________

☐ I AM AN ACTIVE DUTY WARTIME OR CAMPAIGN BADGE VETERAN

I qualify as an active duty wartime or campaign badge veteran because I am a veteran who served on
active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or
expedition for which a campaign badge has been authorized under the laws administered by the
Department of Defense.

☐ I AM AN ARMED FORCES SERVICE MEDAL VETERAN

I qualify as an Armed Forces service medal veteran because I am a veteran who, while serving on
active duty in the U.S. military, ground, naval or air service, participated in a United States military
operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

☐ I AM NOT A PROTECTED VETERAN

☐ I CHOOSE NOT TO SELF IDENTIFY

Last Updated 05/01/2014

 Equal Employment Opportunity Data Form
IMPORTANT - To All Applicants: To enable us to meet government reporting regulations,
please complete this personal data form. Information will be used for government
reporting purposes and will be detached and kept separate from your application. Any
information that you choose to provide will not be considered for employment purposes
and will be treated as confidential. Your voluntary cooperation is appreciated.

Name: Last 4 Digits of SSN:

Last First MI

GENDER: Please check one of the two options below.

Female Male

RACE/ETHNICITY: Please check one of the descriptions below which corresponds to the
ethnic group with which you identify.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central

American, or other Spanish culture or origin, regardless of race.
White (Not Hispanic or Latino): A person having origins in any of the original
peoples of Europe, the Middle East, or North Africa.

Black or African-American (Not Hispanic or Latino): A person having origins in

any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person
having origins in any of the original peoples of Hawaii, Guam, Samoa, or other
Pacific Islands.
Asian (Not Hispanic or Latino): A person having origins in any of the original
peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for
example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino): A person having
origins in any of the original peoples of North and South America (including
Central America), and who maintain tribal affiliation or community attachment.

I do not wish to provide this information

Equal Employment Opportunity Data Form Last updated 11/2009

 DIRECT DEPOSIT INFORMATION
Employee Information – Please Provide Name and Employee ID

____________________________________ _________________ ___________________________________

First & Last Name Employee ID Contact Phone or Email

PLEASE CHECK ONE OF THE FOLLOWING

 Reactivate Direct Deposit from prior account information (No voided check or account information needed)

 Enroll in Direct Deposit *  Add an additional Direct Deposit account *

 Change current Direct Deposit information  Cancel Direct Deposit account

* For Checking, provide a blank and voided check. For Savings, provide a blank and voided deposit slip with printed account number.

PLEASE CHECK ONE OF THE FOLLOWING

 I do not want to receive a paper pay stub, so I can reduce my paper consumption. I understand that I will only be
able to access my pay stub via a Vail Resorts computer.

 I wish to receive a paper pay stub.

MAIN DIRECT DEPOSIT ACCOUNT

___________________________________________________ __________________________________________
Financial Institution Name Account Number

___________________________________________________ Account Type:  Checking or  Savings

Routing/Transit Number (9 digits)

Entire NET PAY will be deposited into this account, unless you set up additional account(s).

ADDITIONAL DIRECT DEPOSIT ACCOUNT #2

___________________________________________________ ____________________________________________
Financial Institution Name Account Number

___________________________________________________ Account Type:  Checking or  Savings

Routing/Transit Number (9 digits)

___________________________________________________
Amount to be deposited ($ or %) * Remainder will be deposited into MAIN ACCOUNT

ADDITIONAL DIRECT DEPOSIT ACCOUNT #3

___________________________________________________ _____________________________________________
Financial Institution Name Account Number

___________________________________________________ Account Type:  Checking or  Savings

Routing/Transit Number (9 digits)

___________________________________________________
Amount to be deposited ($ or %) * Remainder will be deposited into MAIN ACCOUNT

By signing below I hereby authorize the Vail Resorts subsidiary for which I work to make payments of my net pay by initiating credit entries or
correcting entries to the bank accounts I have designated above. I also understand that IT WILL TAKE TWO PAY PERIODS BEFORE MY CHECKS ARE
AUTOMATICALLY DEPOSITED. This authorization shall remain in effect until revoked by me in writing or upon the termination of my employment.

I acknowledge that I am responsible for verifying that my check is being automatically deposited into the correct account.

___________________________________________________________________ ______________________________
Signature Date

Vail Resorts Personal Information and Direct Deposit Information Revised 5/11
 Employee Pay Acknowledgement Form

Vail Resorts Management Company (“Vail Resorts” also referred to as “the Company”) offers two preferred options to
receive your pay, Direct Deposit or the Money Network® Service, as well as a third option of receiving a live, paper check.
Please review these options.

Option 1: DIRECT DEPOSIT The Company will disburse all of my net pay as selected below (“Direct Deposit”) into
the account or accounts (the “Account”) at the financial institution with the routing and account numbers and account
type (collectively, “Account Information”) I have provided separately to the Company according to the Company’s
procedure. Direct Deposit ensures your money is sent directly into your account, prevents a trip to the bank to cash a
check, and is an environmentally friendly option by reducing paper use.
Option 2: MONEY NETWORK SERVICE The Company will disburse all of my net pay as selected below using the
Money Network Service (the “Service”) and I may use either of the following options:

Money Network™ Check. The Money Network Check (“Check”) is a check that I can easily complete on or after each payday
morning wherever I am, eliminating the need to pick up my paycheck. The check can be deposited into my personal bank
account or cashed for free at Money Network check-cashing partners.

Money Network Payroll Debit Card. The Money Network Payroll Debit Card (“Card”) provides a dependable, safe, optional,
and convenient way to receive and access my pay on and after each payday morning with the following features: (i) eliminates
the need to pick up my paycheck, wait for it to be mailed, or, in some instances, to pay for it to be cashed; (ii) immediate,
worldwide access wherever the Card is accepted for ATM cash withdrawals, bank-branch withdrawals, and store purchases
(including “cash back”); (iii) money transfers to a personal or joint checking account; and (iv) free balance inquiries by phone or
online. There is no monthly service charge for the Card as long as I am employed by the Company. Many Card transactions
are free, but there are fees for other transactions. The Terms and Conditions, fee schedule, and other disclosures related to
the Service are included in the Service’s Welcome Packet. Once you have consented to those terms and contracted for the
Service by activating your Service account by following the instructions in the Welcome Packet, you may begin to use the
Service.
Option 3: LIVE PAYCHECK The Company will disburse all of my net pay to a paper check which I can then choose to deposit
to an account of my choice or take to a check cashing facility of my choosing.

1 2 3
DIRECT DEPOSIT OR MONEY NETWORK OR LIVE PAYCHECK
SERVICE

I authorize Vail Resorts Management Company to disburse my pay by Direct Deposit, the Service or by Live Check. I
agree that my pay will be disbursed using the Money Network Service if I don’t make a selection by submitting
required information (Account Information) to Employer within three (3) business days of my hire date OR if I
don’t access my.vailresorts.com within three (3) days and enroll in direct deposit OR opt out of the Service by
marking the “Paycard Opt Out” checkbox. However, I understand that I can change my pay selection at any time
in the future by signing into my.vailresorts.com and updating my pay disbursement option. My election for the
Service will remain in effect unless I change it, or the Company and/or Program Manager cancels this
arrangement with Money Network Service. To help the government fight the funding of terrorism and money
laundering activities, Federal law requires financial institutions to verify and record identity information before opening an
account such as the account provided when you enroll in the Service. If I elect the Service, I authorize the Company to
share my name, address, date of birth, Social Security Number, identification documents, and related personal
information with Money Network and the issuing bank.

EMPLOYER USE ONLY

Signature* Printed Name* Date* Employee ID Number

* Required 11/13/2013
 PERSONAL INFORMATION

__________________________________ __________________________________ _________________

Last Name First Name Employee ID

MAILING ADDRESS
(Your Paycheck, W-2, Insurance Information and Company Correspondence will be sent to this address.)

____________________________________________________________________________________________________
Mailing Address (P.O. Box or Street Number and Name)

___________________________________ ____________________________ ________________________

City State Zip Code

___________________________________
Country

CONTACT

__________________________________________ _______________________________________________________
Primary Phone Primary Personal E-Mail

EMERGENCY CONTACT

____________________________________ _______________________________ ___________________________

Contact Name Relationship Phone Number

____________________________________ _____________________ ________________ ________________

Mailing Address City State Zip Code

By signing this form, I certify that the information I provide on this form is true and complete.

_______________________________________________________________________ __________________________
Signature Date

Vail Resorts Personal Information and Direct Deposit Information Last Updated by Employee Relations 6/29/12
 AGREEMENT TO ASSIGN WAGES

Employee Name: ________________________________________ ID #: _____________

I HEREBY AUTHORIZE GRAND TETON LODGE COMPANY TO MAKE THE

FOLLOWING DESCRIBED DEDUCTION FROM MY WAGES FOR EACH PAY PERIOD:

By initialing below, I authorize the following deductions to be withheld from my wages

for the duration of my employment with the company.

_________ a. Meal Program Fee ($88.00/week)

_________ b. RV Park Site Fee ($6.00/day)

I confirm there are no other wage assignments in existence pertaining to the same
transaction referenced above. I further confirm that the wages or other compensation
assigned above are not subject to any other wage assignments or withholding orders. If
another assignment of wages exists, I understand that this request will be invalid and this
deduction cannot be processed until I revoke, in writing, my authorization for the prior
assignment of wages.

The requested deduction from my wages or other compensations shall commence on the
next payday following the date of this authorization and continue each payday thereafter
until the entire amount of the underlying obligation for which the deduction is being made
shall have been paid in full, or the benefit or service for which the deduction is being
made is terminated. I understand that any change to the deduction(s) authorized below,
including revocation of this authorization, must be made in writing and delivered to my
employer and that it will become effective as soon as is feasible after receipt by my
employer. Nothing in this Authorization shall be construed to limit the at-will employment
relationship between myself and Grand Teton Lodge Company.

I further agree that, if my employment is terminated and there is any remaining balance
due on the total amount according to the terms of the agreements for which the above-
described deduction(s) are authorized, the remaining balance shall be due and payable in
full to the Grand Teton Lodge Company within thirty days thereafter.

Printed Name: ______________________________________

Signature: ___ Date: ___________

 Notice, Authorization and Release
for Consumer and/or Investigative
Consumer Report for Employment Purposes
I, ___________________________________ (print name legibly), authorize Vail Resorts, Inc., or the subsidiary with which I am applying for
employment or reemployment (collectively referred to as “Vail Resorts”), through a consumer reporting agency selected by Vail Resorts, to obtain a
consumer report and/or an investigative consumer report on me. I understand that this authorization may be used to obtain a report for any initial
employment consideration, during any period of employment, including for purposes of promotion, reassignment, or retention, and for any
consideration of reemployment.

I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to , the following areas: Social
Security Number trace, current and previous residences, employment history including all personnel files, education, character references, credit
history and reports, criminal history records from any criminal justice agency in any or all federal, state county jurisdictions, motor vehicle records to
include traffic citations and registration and any other public records.

I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may
have. I understand that I must provide my date of birth to adequately complete said screenings, and acknowledge that my date of birth will not affect
any hiring decisions. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons
having personal knowledge of me, to furnish the bearer of this form with any and all information in their possession. This authorization and consent
shall be valid of original, fax, or copy form.

I release Vail Resorts, and its agents and any person or entity that provides information pursuant to this authorization, from any and all liabilities,
claims or law suits in regards to the information obtained from any and all of the above referenced sources used. I acknowledge that I have received
a copy of “A Summary of Your Rights Under the Fair Credit Reporting Act.” The following is my true and complete legal name and all information is
true and correct to the best of my knowledge:

Printed Name (last, first, middle initial) Other names (alias, maiden, etc.) Years Used

/ /
Driver’s License Number State Date of Birth Gender

from to
Street/PO Box City State Zip County Year Year

PLEASE LIST ALL ADDRESSES FOR LAST SEVEN (7) YEARS (Use back of form if needed)

from to
Street/PO Box City State Zip County Year Year

from to
Street/PO Box City State Zip County Year Year

HAVE YOU BEEN CONVICTED OF ANY LAW VIOLATION? Include any plea of ‘Guilty’ or ‘No Contest’. Exclude juvenile offenses and minor traffic
violations. California employees exclude convictions for personal marijuana use that are more than two years old, convictions that have been sealed,
eradicated or expunged, or misdemeanors that were dismissed after probation. A conviction will not necessarily disqualify you for employment.

YES NO

If “Yes,” provide details: _________________________________________________________________________ and date(s) ______________

________________________________________________________________________________ ___________________
SIGNATURE DATE

I would like a copy of my report: YES NO

Release for Consumer Report Last Revised April 2011

Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer
Financial Protection Bureau, 1700 G Street N.W., Washington DC 20006.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in
the files of consumer reporting agencies. There are many types of consumer reporting agencies, including
credit bureaus and specialty agencies (such as agencies that sell information about check writing histories,
medical records, and rental history records). Here is a summary of your major rights under the FCRA. For
more information, including information about additional rights, go to
www.consumerfinance.gov/learnmore or write to Consumer Financial Protection Bureau, 1700 G
Street N.W., Washington DC 20006.

You may have additional rights under Maine’s FCRA, Me. Rev. Stat. Ann. 10, Sec 1311 et seq.

• You must be told if information in your file has been used against you. Anyone who uses a credit
report or another type of consumer report to deny your application for credit, insurance, or
employment – or to take another adverse action against you – must tell you, and must give you the
name, address, and phone number of the agency that provided the information.

• You have the right to know what is in your file. You may request and obtain all the information
about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to
provide proper identification, which may include your Social Security number. In many cases, the
disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit
report;
• you are the victim of identify theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers will be entitled to one free disclosure every 12 months upon request
from each nationwide credit bureau and from nationwide specialty consumer reporting agencies.
See www.consumerfinance.gov/learnmore for additional information.

• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-
worthiness based on information from credit bureaus. You may request a credit score from consumer
reporting agencies that create scores or distribute scores used in residential real property loans, but you
will have to pay for it. In some mortgage transactions, you will receive credit score information for free
from the mortgage lender.

• You have the right to dispute incomplete or inaccurate information. If you identify information in
your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency
must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an
explanation of dispute procedures.

• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable

information. Inaccurate, incomplete or unverifiable information must be removed or corrected,
usually within 30 days. However, a consumer reporting agency may continue to report information it
has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most cases, a
consumer reporting agency may not report negative information that is more than seven years old, or
bankruptcies that are more than 10 years old.

• Access to your file is limited. A consumer reporting agency may provide information about you
only to people with a valid need -- usually to consider an application with a creditor, insurer, employer,
landlord, or other business. The FCRA specifies those with a valid need for access.

• You must give your consent for reports to be provided to employers. A consumer reporting agency
may not give out information about you to your employer, or a potential employer, without your
written consent given to the employer. Written consent generally is not required in the trucking
industry. For more information, go to www.consumerfinance.gov/learnmore.

• You may limit “prescreened” offers of credit and insurance you get based on information in your
credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll- free
phone number you can call if you choose to remove your name and address from the lists these offers
are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.

• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of
consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you
may be able to sue in state or federal court.

• Identity theft victims and active duty military personnel have additional rights. For more
information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases,
you may have more rights under state law. For more information, contact your state or local consumer
protection agency or your state Attorney General. Federal enforcers are:
TYPE OF BUSINESS:
1.a. Banks, savings associations, and credit unions with total assets of over $10
billion and their affiliates.
b. Such affiliates that are not banks, savings associations, or credit unions also
should list, in addition to the bureau:
2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal branches and federal
agencies of foreign banks
b. State member banks, branches and agencies of foreign banks (other than federal
branches, federal agencies, and insured state branches of foreign banks),
commercial lending companies owned or controlled by foreign banks, and
organizations operating under section 25 or 25A of the Federal Reserve Act
c. Nonmember Insured Banks, Insured State Branches of Foreign banks, and
insured state savings association
d. Federal Credit Unions
3. Air carriers
4. Creditors Subject to Surface Transportation Board
5. Creditors Subject to Packers and Stockyards Act
6. Small Business Investment Companies
7. Brokers and Dealers
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate
Credit Banks, and Production Credit Associations
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
CONTACT:
a. Bureau of Consumer Financial Protection, 1700 G Street NW, Washington DC
20006
b. Federal Trade Commission: Consumer Response Center—FCRA, Washington, DC
20580, (877) 382-4357
a. Office of the Comptroller of the Currency Customer Assistance Group, 1301
McKinney Street, Suite 4350, Houston, TX 77010-9050
b. Federal Reserve Consumer Help Center, P.O. Box 1200, Minneapolis, MN 55480
c. FDIC Consumer Response Center, 1100 Walnut Street, Box #11, Kansas City, MO
64106
d. National Credit Union Administration Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO), 1775 Duke Street,
Alexandria, VA 22314
Asst. General Counsel for Aviation Enforcement & Proceedings Department of
Transportation, 400 Seventh Street SW, Washington, DC 20590
Office of Proceedings, Surface Transportation Board, Department of Transportation,
1925 K Street NW, Washington, DC 20423
Nearest Packers and Stockyards Administration area supervisor
Associate Deputy Administrator for Capital Access, United States Small Business
Administration, 406 Third Street, SW, 8th Floor, Washington, DC, 20549
Securities and Exchange Commission, 100 F St NE, Washington DC 20549
Farm Credit Administration, 1501 Farm Credit Drive, McLean, VA 22102-5090
FTC Regional Office for region in which the creditor operates or Federal Trade
Commission: Consumer Response Center—FCRA, Washington, DC 20580, (877)
382-4357

November 2012
 HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS
AND YOUR HEALTH COVERAGE

PART A: GENERAL INFORMATION

When key parts of the health care law t o o k effect in 2014, there was a new way to buy health insurance
created: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this
notice provides some basic information about the new Marketplace and employment based health coverage
offered by the Company1.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget.
The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also
be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for 2015
health insurance coverage through the Marketplace begins in November 15th 2014. If you enroll between the 1st
and 15th your coverage starts the first day of the next month. If you enroll between the 16th and the last day of the
month your coverage starts the first day of the second following month.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if you are not eligible for coverage
through the Company. The savings on your premium that you're eligible for depends on your household
income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you are eligible for health coverage through the Company, you will not be eligible for a tax credit through
the Marketplace. However, you may be eligible for a tax credit that lowers your monthly premium, or a
reduction in certain cost-sharing if you are not eligible for coverage through the Company. If the cost of a plan
from your employer that would cover you (and not any other members of your family) is more than 9.5% of
your household income for the year, or if the coverage your employer provides does not meet the "minimum
value" standard set by the Affordable Care Act, you may be eligible for a tax credit.2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by the
Company, then you will lose the employer contribution (if any) to the employer-offered coverage. Also, this
employer contribution, as well a s your employee contribution to employer-offered coverage, is excluded from
income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are
made on an after- tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan
description or contact the Vail Resorts Benefits Services Group at 303-404-1010, or at
vailbenefits@vailresorts.com.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through
the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for
health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 This refers to employees of each company that is part of the family of companies wholly-owned by Vail Resorts, Inc. who may be eligible for
employment-based health coverage.
2 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the
plan is no less than 60 percent of such costs.
PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER
This section contains information about any health coverage offered by the Company. If you decide to
complete an application for coverage in the Marketplace, you will be asked to provide this information.

Employer Name: The Vail Corporation Employer Identification Number: 84-0601461

Employer Address: 390 Interlocken Crescent Employer Phone Number: 303 404-1010

City: Broomfield State: CO Zip Code: 80021

Who can I contact about employee health coverage at this job?

Your local Human Resources or the Vail Benefit Services Group
Email Address: VailBenefits@VailResorts.com

As your employer, we offer a health plan to some employees. Eligible employees include:
• Year Round Full Time: Employees designated as Full Time and working an average of 30 hours per week.
• 10-11 Month Full Time: Work an average of 30 hours per week. However, during designated months off, these
employees will remain active and are not required to meet the 30 hours per week threshold.
• Season To Season Full Time: Work an average of 30 hours per week. Have three continuous years of service,
with no more than two breaks in service per year (not to exceed four weeks each). Work both Summer and
Winter seasonal jobs with more than 4,800 hours of service. Have applied for and been granted Season to
Season Full Time status.
• Seasonal Full Time with MORE than 750 service hours: Work an average of 30 hours per week. Please reference
your benefits guide for further eligibility details.

With respect to dependents, we offer coverage to dependents of eligible employees, excluding dependents of
Seasonal Lodging employees. Eligible dependents are:
• Your spouse (unless legally separated), state-registered spousal equivalent or domestic partner (same sex
only).
• Your natural, step, legally-adopted or eligible foster children up to age 26 regardless of marital status,
employment status, full-time student status or federal tax dependency.
• An unmarried disabled child may be considered eligible beyond age 26 if he/she is incapable of self-sustaining
employment due to mental or physical disability and is primarily dependent on you for support and
maintenance. Proof of such incapacity must be provided to the Company within 30 days of the child’s 26th
birthday.
• Your children who are recognized under a Qualified Medical Child Support Order (QMCSO).

This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable, based on employee wages.
If you de ci de to shop for coverage on the Marketplace, HealthCare.gov will guide you through the process and
help calculate if you may be eligible for a premium discount. Each state may have different options and it is best to
check your local state exchanges. Below are some helpful resources.

California Covered California 800-300-1506 www.coveredca.com

Colorado Connect For Health Colorado 855-752-6749 www.connectforhealthco.com
Michigan Michigan DIFS 877-999-6442 www.healthcare.gov
Minnesota MNsure 855-366-7873 www.mnsure.org
Utah HealthCare.gov 855-850-2834 www.healthcare.gov
Wyoming HealthCare.gov 800-318-2596 www.healthcare.gov