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 TRUST HAS CONTRACTED WITH TITAN INSURANCE ADMINISTRATORS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 8B: | THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION B, LINE 11B: | A COPY OF FORM 990 WAS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C: | AT LEAST ONCE A YEAR, TRUSTEES AND OTHER FIDUCIARIES SUBJECT TO THE CONFLICT-OF-INTEREST POLICY WILL BE ASKED TO DISCLOSE IN WRITING ANY RELATIONSHIP OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. SHOULD ANY INDIVIDUAL COVERED BY THE POLICY DETERMINE OR SUSPECT THAT HE OR SHE POSSESSES AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, SUCH INDIVIDUAL MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST OR RELATIONSHIP GIVING RISE TO THE CONFLICT AND DISCLOSE ALL RELEVANT FACTS PRIOR TO ANY DECISION TO ENTER INTO ANY PROPOSED TRANSACTION OR ARRANGEMENT OR, IF LATER, AS SOON AS THE ACTUAL OR POTENTIAL CONFLICT IS RECOGNIZED. THE TRUSTEE OR OTHER FIDUCIARY WITH THE CONFLICT OF INTEREST MUST BE EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION AND THE CONFLICTED INDIVIDUAL IS NOT ALLOWED TO INFLUENCE THE BOARD'S DECISION IN ANY WAY. |
| FORM 990, PART VI, SECTION C, LINE 19: | THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. |
| FORM 990, PART VII, SECTION A, LINE 1A: | TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, LIPMAN INSURANCE ADMINISTRATORS. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. |
| FORM 990, PART V, LINE 2A: | THE PLAN DOES NOT HAVE EMPLOYEES. HOWEVER, CERTAIN PARTICIPANTS OF THE PLAN RECEIVED A FORM W-2 FOR TAXABLE DOMESTIC PARTNER BENEFITS. |
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