Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990-EZ, Part I, Line 2 | Employer contributed $140,000 to the plan, but received a refund of $1,151 for cancelled claims. The amount on this line is the net amount contributed. |
| Form 990-EZ, Part I, Line 11 | Amount is net of the refund paid directly to the employer for claims cancellations. |
| Software ID: | 17005980 |
| Software Version: | v1.00 |