Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE FORM 990 WAS PROVIDED TO THE TRUST ADMINISTRATOR, THE MEMBERS OF THE BOARD OF DIRECTORS, AND THE OUTSIDE ACCOUNTING SERVICES PREPARER VIA EMAIL FOR REVIEW PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE COVERED BY THE POLICY. THE BOARD DETERMINES IF CONFLICTS EXIST AND ALL POTENTIAL CONFLICTS ARE REVIEWED BY THE BOARD. ANY PERSONS WITH A CONFLICT ARE NOT ALLOWED TO VOTE ON CONFLICTED ISSUES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 173,450. PRIOR PERIOD ADJUSTMENTS: 36,554. TOTAL TO FORM 990, PART XI, LINE 5: 210,004. |
| FORM 990, PART XI, LINE 1: MODIFIED CASH | ||
| FORM 990, PART V, LINE 3A AND 3B | THE ORGANIZATION IS ELECTING TO SET ASIDE INVESTMENT INCOME FOR THE PURPOSE OF PAYMENTS FOR HEALTH BENEFITS TO ITS MEMBERS. THE SET ASIDE ELECTION HAS BEEN MADE BY FILING SCHEDULE G OF FORM 990-T, IN ADDITION TO COMPLETING A SCHEDULE IN SUPPORT OF INCOME SET ASIDE AS ATTACHED TO THE 990-T. |
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