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 TRUSTEES FOR THE FUND ENGAGED CENTRAL DATA SERVICES (CDS ADMINISTRATORS, INC) TO PROVIDE ADMINISTRATIVE SERVICES FOR THE PLAN EFFECTIVE 10/1/2016. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE COMPLETED 990, IN DRAFT VERSION, IS EMAILED TO THE CO-CHAIRMEN PRIOR TO ITS FINALIZATION. ANY QUESTIONS, COMMENTS, AND CONCERNS ARE DISCUSSED AND RESOLVED PRIOR TO THE FILING OF THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR ADMINISTRATOR OF THE ORGANIZATION HAS A DUTY TO DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST AND IS GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE GOVERNING BOARD. THE GOVERNING BOARD THEN DISCUSSES AND VOTES UPON THE DETERMINATION OF A CONFLICT OF INTEREST. IF THE BOARD BELIEVES THAT AN ACTUAL OR POSSIBLE CONFLICT WAS NOT DISCLOSED AND UPON FURTHER EXPLANATION DETERMINES THAT THERE WAS A FAILURE TO DISCLOSE, APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION WILL BE TAKEN. EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR ADMINISTRATOR OF THE GOVERNING BOARD IS REQUIRED TO SIGN AN ANNUAL STATEMENT. PERIODIC REVIEWS WILL ALSO BE CONDUCTED WHICH MAY INCLUDE THE USE OF OUTSIDE EXPERTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | CONSULTANT FEES 52,940. PROVIDER AND ADMINISTRATIVE EXPENSES 876,680. |
| FORM 990, PART IX, LINE 11(G) | MEDICAL PROVIDER 378,601 PRESCRIPTION PROVIDER 51,442 DENTAL PROVIDER 14,169 THIRD PARTY ADMINISTRATOR 300,720 WEX HEALTH/BENNY CARD 10,641 PAYD HEALTH 121,108 |
| PART XII, LINE C2 EXPLANATION: | THE PROCESS HAS NOT CHANGED. |
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