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 TRUST HAS DELEGATED CONTROL OVER THE CLAIMS PAYMENT PROCESS TO AN OUTSIDE THIRD-PARTY PROCESSOR PURSUANT TO A WRITTEN CONTRACT. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS MEMBERS WHO ARE BENEFICIARIES OF THE VEBA (TRUST) AND RECEIVE REIMBURSEMENT OF ELIGIBLE MEDICAL EXPENSES IN ACCORDANCE WITH THE HRA PLAN DOCUMENT. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE VEBA COMMITTEE HAS THE AUTHORITY TO APPOINT AND REMOVE, EMPLOY AND DISCHARGE, AND PRESCRIBE THE DUTIES AND FIX THE COMPENSATION, IF ANY, OF ALL OFFICERS, AGENTS AND THIRD PARTY SERVICE PROVIDERS OF THE TRUST. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS DISTRIBUTED TO EACH MEMBER OF THE VEBA COMMITTEE. THE COMMITTEE MEETS TO DISCUSS AND APPROVE THE FORM 990 BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION DOES NOT HAVE PROCESSES FOR REVIEWING AND APPROVING THE COMPENSATION OF THE CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICAL OR OTHER OFFICERS OR KEY EMPLOYEES BECAUSE THE ORGANIZATION DOES NOT HAVE PERSONS SERVING IN SUCH POSITIONS. ACCORDINGLY SUCH PROCESSES WOULD NOT BE APPLICABLE TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE TRUST AGREEMENT, HRA PLAN DOCUMENTS AND OTHER GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. BENEFICIARIES OF THE TRUST (AND PARTICIPANTS IN THE HRA PLAN) MAY REQUEST COPIES OF HRA PLAN DOCUMENTS AND THE FORM 5500, AND WILL BE PROVIDED WITH A SUMMARY ANNUAL REPORT (SAR) FOR THE HRA PLAN PER ERISA REQUIREMENTS. |
| FORM 990, PART XII, LINE 2(C): | THE ENTIRE VEBA COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND IS INVOLVED IN THE SELECTION OF THE AUDITOR AND THE REVIEW OF THE FINANCIAL STATEMENTS AND AUDITOR'S REPORT ISSUED BY THE INDEPENDENT AUDITOR. |
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