Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, line 3 | Effective 1/1/2022, the Plan changed from self insured health benefits to fully insured. The remaining unpaid health insurance claims incurred during 2021 were paid out during 2022. |
| Form 990, Part VI, Section A, line 8a | Plan management is the governing body even though there is no specific document stating so. Plan management reviews and monitors activity, however, no formal documentation of meetings held or actions taken. Plan management reviews Form 990 prior to filing. |
| Form 990, Part VI, Section A, line 8b | Plan management is the governing body even though there is no specific document stating so. Plan management reviews and monitors activity, however, no formal documentation of meetings held or actions taken. Plan management reviews Form 990 prior to filing. |
| Form 990, Part VI, Section B, line 11b | Plan management is the governing body even though there is no specific document stating so. Plan management reviews and monitors activity, however, no formal documentation of meetings held or actions taken. Plan management reviews Form 990 prior to filing. |
| Form 990, Part VI, Section C, line 19 | ALL INFORMATION IS AVAILABLE UPON REQUEST. |
| Form 990, Part IX, line 11g | Insurance Advisory Fees: Program service expenses 0. Management and general expenses 8,542. Fundraising expenses 0. Total expenses 8,542. |
| Part IX, Line 4 | Estimated benefits accrued at 12/31/2021 were greater than actual benefits incurred, resulting in negative benefits expense in 2022. |
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