| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | MEDICAL, HOSPITAL, VISION, PRESCRIPTION, TEMPORARY DISABILITY, AND DEATH BENEFITS PROVIDED TO ELIGIBLE EMPOYEES AND THEIR DEPENDENTS. |
| FORM 990, PART V | LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096: THE FUND PROVIDED 3 1099-NEC TO SERVICE PROVIDERS, 21 1099-MISC TO MEDICAL SERVICE PROVIDERS, AND 7 1099R TO PARTICIPANTS RECEIVING DEATH BENEFITS. LINE 2A, NUMBER REPORTED ON FORM W-3: THE FUND HAS NO EMPLOYEES. W-2'S 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 | SUMMARY PLAN DESCRIPTIONS AND SUMMARY ANNUAL REPORTS ARE MAILED TO ALL PARTICIPANTS. ALL OTHER GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CLAIMS ADMIN & PROCESSING 110,830 0 0 ACTUARIAL FEES 72,804 0 0 TOTAL 183,634 0 0 |
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