Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE FUND HAS AN AGREEMENT WITH MUTUAL MEDICAL OF ROCKFORD, INC. TO PERFORM CERTAIN THIRD PARTY ADMINISTRATIVE DUTIES. THE TPA AGREES TO PROVIDE BENEFITS TO OR ON BEHALF OF PARTICIPANTS IN THE PLAN SPONSOR'S MEDICAL, DENTAL, VISION, AND DISABILITY BENEFITS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PROVIDED TO THE CHAIRMAN OF THE BOARD FOR REVIEW AND APPROVAL PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HEALTH AND WELFARE FUND MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, LINES 12, 13, AND 14 | ALTHOUGH FORMAL CONFLICT OF INTEREST, DOCUMENT RETENTION, AND WHISTLEBLOWER POLICIES WERE NOT ADOPTED AS OF THE PLAN'S YEAR END, SUCH POLICIES HAVE BEEN ADOPTED AS OF THE TIME OF THIS FILING. |
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