Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART V | LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096: THE FUND PROVIDED 92 1099S TO MEDICAL SERVICE PROVIDERS AND 2 1099S TO OTHER SERVICE PROVIDERS. LINE 2A, NUMBER REPORTED ON FORM W-3: THE FUND HAS NO EMPLOYEES. W-2S WERE PROVIDED TO PARTICIPANTS RECEIVING DISABILITY PAYMENTS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE FORM 990 IS E-MAILED TO EACH TRUSTEE FOR REVIEW PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICTS ARE DISCLOSED DURING TRUSTEE MEETINGS, IF A CONFLICT ARISES THE TRUSTEE ABSTAINS FROM VOTING. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THIS QUESTION DOES NOT APPLY FOR THIS ORGANIZATION, AS THESE POSITIONS DO NOT EXIST. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THIS QUESTION DOES NOT APPLY FOR THIS ORGANIZATION, AS THESE POSITIONS DO NOT EXIST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SUMMARY PLAN DESCRIPTIONS, SUMMARIES OF MATERIAL MODIFICATIONS, AND SUMMARY ANNUAL REPORTS ARE MAILED TO ALL PARTICIPANTS. |
| FORM 990, PART IX, LINE 11G | ANTHEM ADMIN 133,036 0 0 ANTHEM ACCESS 48,000 0 0 ACTUARIAL FEES 98,740 0 0 TOTAL 279,776 0 0 |
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