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 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 11B | THE FORM 990 IS PROVIDED TO THE CHAIRMAN OF THE BOARD FOR REVIEW AND APPROVAL PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | PLAN TRUSTEES ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY AT LEAST ANNUALLY FOR REVIEW WHICH IS EXPRESSLY DOCUMENTED IN THE PLAN'S MEETING MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HEALTH AND WELFARE FUND MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
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