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 PLAN ADMINISTRATOR HAS CONTRACTED HEALTHSCOPE BENEFITS TO ACT AS A THIRD PARTY ADMINISTRATOR. THEY PERFORM ALL DAY-TO-DAY MANAGERIAL AND ADMINISTRATIVE DUTIES. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS SIGNED BY A MEMBER OF THE FUND'S BOARD OF TRUSTEES PRIOR TO FILING. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| PART VI, LINE 12B | THE POLICY DOES NOT REQUIRE TRUSTEES TO MAKE AN ANNUAL DISCLOSURE. |
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