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 8 - OTHER REVENUE | DESCRIPTION: REIMBURSE OF CHANGE HEALTH CARE FEES. AMOUNT: 7725. DESCRIPTION: CHANGE IN IBNR. AMOUNT: 9000. TOTAL TO FORM 990-EZ, LINE 8: 16725. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: BANK FEES. AMOUNT: 2036. DESCRIPTION: CLAIM PROCESSING FEE. AMOUNT: 5211. TOTAL TO FORM 990-EZ, LINE 16: 7247. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: PREPAID EXPENSE. BEG. OF YEAR AMOUNT: 5843. END OF YEAR AMOUNT: 0. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 104. END OF YEAR AMOUNT: 0. DESCRIPTION: IBNR. BEG. OF YEAR AMOUNT: 9000. END OF YEAR AMOUNT: 0. |
| FORM 990-EZ, PART IV | TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER TAX-EXEMPT ORGANIZATIONS IS REPORTED ON THE FORM 990EZ FILED WITH THE IRS BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE PLAN ADMINISTRATOR. |
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