Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| PART I, LINE I AND PART III, LINES 1 AND 4A: | TO PROVIDE MEDICAL, PRESCRIPTION, DRUG, DENTAL, VISION, SHORT-TERM DISABILITY, DEATH, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF EMPLOYERS CONTRIBUTE TO THE PLAN IN ACCORDANCE WITH THEIR COLLECTIVE BARGAINING AGREEMENT. |
| PART VI, LINE 11B: | FORM 990 WAS REVIEWED BY THE PLAN ADMINISTRATOR PRIOR TO FILING; ANY UNUSUAL ITEMS OR ITEMS NEEDING TO BE ADDRESSED WILL BE BROUGHT TO THE TRUSTEES' ATTENTION. |
| PART VI, LINE 12C: | TRUSTEES ARE REQUIRED TO NOTIFY THE PLAN OF ANY CHANGES IN THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS. |
| PART VI, LINE 19: | THE PLAN DOCUMENT, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE PLANS' OFFICE AND ARE AVAILABLE UPON REQUEST. |
| PART VII, SECTION A: | TRUSTEE COMPENSATION AND BENEFITS FROM RELATED TAX-EXEMPT ORGANIZATIONS IS PROPERLY REPORTED AND AVAILABLE ON THOSE ORGANIZATIONS' TAX FILINGS. |
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