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 | DAY TO DAY TASKS WERE DELEGATED TO A THIRD PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED AND SIGNED BY THE CHAIRMAN OF THE BOARD OF TRUSTEES PRIOR TO FILING. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS THAT ARE AVAILABLE TO PUBLIC WILL BE SENT UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | MEDICARE GAP REIMBURSEMENT -64,679. |
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