UNITED FOOD & COMMERCIAL WORKERS & EMPS ARIZONA HEALTH & WELFARE TR: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UNITED FOOD & COMMERCIAL WORKERS & EMPS ARIZONA HEALTH & WELFARE TR (EIN 23-7244353)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-13
IRS object ID
201102869349301310
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-10-13T17:42:36-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MILLER KAPLAN ARASE & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14123 LANKERSHIM BLVDAddressLine1
CityNORTH HOLLYWOODCity
StateCAState
ZIP Code916022828ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237244353EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNITED FOOD AND COMMERCIAL WORKERS ANDBusinessNameLine1
Business Name Line2EMPLOYERS ARIZONA HEALTH & WELFARE TRUSTBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUNITNameControl
Phone6022493582Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12400 WEST DUNLAP AVENUEAddressLine1
CityPHOENIXCity
StateAZState
ZIP Code850212811ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePaul RubinName
Titleunion trusteeTitle
Date Signed2011-10-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMiller Kaplan Arase Co LLPName
Phone8187692010Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES MCLAUGHLINNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12400 W DUNLAP AVE STE 250AddressLine1
CityPHOENIXCity
StateAZState
ZIP Code850212811ZIPCode
FieldValueIRS element (for citing)
Gross Receipts124158470GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1968YearFormation
State Legal DomicileAZStateLegalDomicile
Activity Or Mission DescriptionSEE SCHEDULE OActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees989TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year117971127ProgramServiceRevenuePriorYear
Program Service Revenue CY123183519ProgramServiceRevenueCY
Investment Income Prior Year328913InvestmentIncomePriorYear
Investment Income Current Year-134241InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year118300040TotalRevenuePriorYear
Total Revenue Current Year123049278TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year112644173BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY116373762BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9332994OtherExpensePriorYear
Other Expenses Current Year9233477OtherExpensesCurrentYear
Total Expenses Prior Year121977167TotalExpensesPriorYear
Total Expenses Current Year125607239TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3677127RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2557961RevenuesLessExpensesCY
Total Assets BOY38177280TotalAssetsBOY
Total Assets EOY38778590TotalAssetsEOY
Total Liabilities BOY33204808TotalLiabilitiesBOY
Total Liabilities EOY35749053TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4972472NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3029537NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionTHE UNITED FOOD AND COMMERCIAL WORKERS AND EMPLOYERS ARIZONA HEALTH AND WELFARE TRUST IS A MULTIEMPLOYER WELFARE BENEFIT PLAN PROVIDING MEDICAL-HOSPITAL, DENTAL, PRESCRIPTION, VISION, DISABILITY, DEATH AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO PARTICIPANTS.Description
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10965875NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees989NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledAZStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBARBARA RAYNamePerson
Telephone Number6022493582TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 W DUNLAP AVE STE 250AddressLine1
CityPHOENIXCity
StateAZState
ZIP Code850212811ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
PETER BARTH
EMPLOYER TRUSTEE4.0X000
STUART MARCUS
EMPLOYER TRUSTEE4.0X000
JAMES NYGREN
EMPLOYER TRUSTEE4.0X000
FRANK STEGMAN
EMPLOYER TRUSTEE4.0X000
JOHN MCCARTHY
UNION TRUSTEE4.0X000
JAMES MCLAUGHLIN
UNION TRUSTEE4.0X000
PAUL RUBIN
UNION TRUSTEE4.0X000
JACOB SEDILLO
UNION TRUSTEE4.0X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SOUTHWEST SERVICE ADMINISTRATORS IN
2400 WEST DUNLAP AVENUE SUITE 250PHOENIXAZ850212811ADMIN. SERVICES5166600
BLUE CROSS BLUE SHIELD OF ARIZONA
2444 WEST LAS PALMARITAS DRIVEPHOENIXAZ850214860COST CONTAINMENT1720194
PATIENT CARE PARTNERSHIP
2400 WEST DUNLAP AVENUE SUITE 250PHOENIXAZ850212811MEDICAL BILLING REV.493811
NAT'L MEDICAL HEALTH CARD SYSTEMS
23 BRITISH AMERICAN BLVDLATHANNY121101435PHARMACY BENEFIT MGM312347
RYAN RAPP UNDERWOOD PLC
3200 N CENTRAL AVE STE 1600PHOENIXAZ850122401LEGAL SERVICES140705
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS900099121544947121544947
EMPLOYEE CONTRIBUTIONS900099335287335287
ASSISTANCE ELIGIBLE IND. COBRA SUBSIDY9000994564945649
RETIREE SELF-PAYMENTS90009912576361257636
FieldValueIRS element (for citing)
Total Program Service Revenue123183519TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column274951TotalRevenueColumn
Exclusion$274,951ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities700000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1109192Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-409192Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-409192TotalRevenueColumn
Exclusion-$409,192ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column123049278TotalRevenueColumn
Related Or Exempt Function Income123183519RelatedOrExemptFunctionIncome
Exclusion-$134,241ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total116373762Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4473661Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total140705Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total40866Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total59976Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total731600Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total770348Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total53843Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total46023Total

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotal
MEDICAL NETWORK ACCESS FEES1720194
MAYO HEALTH NW PPO FEES493811
CASE MANAGEMENT FEES286566
PRESCRIPTION ADMIN. FEES312347
VISION ADMINISTRATION FEES103537

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total125607239Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5707042BOY
EOY6498368EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5BOY
EOY6EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9506430BOY
EOY9533875EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY22963803BOY
EOY22746341EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY38177280BOY
EOY38778590EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY461208BOY
EOY539953EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY32743600BOY
EOY35209100EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY33204808BOY
EOY35749053EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY4972472BOY
EOY3029537EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4972472BOY
EOY3029537EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38177280BOY
EOY38778590EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2557961ReconcilationRevenueExpenses
Reconcilation Other Changes615026ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements
EquipmentEquipment
Other Land BuildingsOtherLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionBENEFIT OBLIGATIONSDescription
Amount$35,209,100Amount
FieldValueIRS element (for citing)
Total Of Amounts35209100TotalOfAmounts
Total Revenue123049278TotalRevenue
Total Expenses125607239TotalExpenses
Excess Or Deficit For Year-2557961ExcessOrDeficitForYear
Net Unrealized GL On Investments615026NetUnrealizedGLOnInvestments
Total Adjustments615026TotalAdjustments
Excess Or Deficit Per FS-1942935ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt123664304TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments615026NetUnrealizedGainsInvestments
Revenue Not Rptd F990615026RevenueNotRptdF990
Revenue Subtotal123049278RevenueSubtotal
Total Revenue Per Form990123049278TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt125607239TotExpensesEtcAuditedFinclStmt
Expenses Subtotal125607239ExpensesSubtotal
Total Expenses Per Form990125607239TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPART X, LINE 2:Identifier
ExplanationTHE PLAN HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierPART I, LINE 1 AND PART III, LINE 1 - ORGANIZATION'S MISSION:Identifier
Return ReferenceTHE UNITED FOOD AND COMMERCIAL WORKERS AND EMPLOYERS ARIZONA HEALTH ANDReturnReference
ExplanationWELFARE TRUST IS A MULTIEMPLOYER WELFARE BENEFIT PLAN PROVIDING MEDICAL-HOSPITAL, DENTAL, PRESCRIPTION, VISION, DISABILITY, DEATH AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO PARTICIPANTS. PART VI, QUESTION 11B: FORM 990 IS PRESENTED FOR REVIEW AND SIGNATURE AT BOARD OF TRUSTEE MEETINGS. PART VI, QUESTIONS 15A AND 15B: THE BOARD OF TRUSTEES DO NOT RECEIVE COMPENSATION. THE ORGANIZATION DOES NOT HAVE OTHER OFFICERS OR "KEY EMPLOYEES", AS DEFINED. PART VI, QUESTION 19: GOVERNING DOCUMENTS - NO DOCUMENTS AVAILABLE TO THE PUPLIC. FINANCIAL STATEMENTS - AUDITED STATEMENTS ONLY ARE AVAILABLE UPON REQUEST. PART XI, LINE 5: NET UNREALIZED APPRECIATION IN FAIR VALUE OF INVESTMENTS $615,026Explanation

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