Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE TRUST HAS CONTRACTED WITH HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC., TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. REVIEW OF THE FORM 990 WAS CONDUCTED BY THE BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AT LEAST ONCE A YEAR, TRUSTEES AND OTHER INDIVIDUALS WHO ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY WILL BE ASKED TO DISCLOSE IN WRITING ANY RELATIONSHIP OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. SHOULD ANY INDIVIDUAL COVERED BY THE POLICY DETERMINE OR SUSPECT THAT HE OR SHE POSSESSES AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, SUCH INDIVIDUAL MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST OR RELATIONSHIP GIVING RISE TO THE CONFLICT AND DISCLOSE ALL RELEVANT FACTS PRIOR TO PARTICIPATING IN ANY DECISION TO ENTER INTO ANY PROPOSED TRANSACTION OR ARRANGEMENT OR, IF LATER, AS SOON AS THE ACTUAL OR POTENTIAL CONFLICT IS RECOGNIZED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE TO THE PARTICIPANTS. |
| FORM 990 PART VII, SECTION A, LINE 1A | TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. |
| FORM 990 PART XII, LINE 2C | THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. |
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