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 16 | EXPENSES BANK SERVICE CHARGES 36 ADMINISTRATION 1,358 REFUNDS 55 TOTAL 1,449 |
| FORM 990-EZ, PART II, LINE 24 | OTHER 5,947 5,947 TOTAL 5,947 5,947 |
| FORM 990-EZ, PART III | TO SUPPLEMENT ELIGIBLE MEMBERS WITH FUNDS TO DEFRAY EXPENSES INCURRED AS AN IN-PATIENT OF AN ACCREDITED HOSPITAL. |
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