SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
SOUTHERN CALIFORNIA LOCAL 831 -
EMPLOYER HEALTH FUND
Employer identification number

95-6047878
Return Reference Explanation
PART I, LINE 1 AND PART III, LINE 1 AND 4A - ORGANIZATION'S MISSION: THE SOUTHERN CALIFORNIA LOCAL 831 - EMPLOYER HEALTH FUND IS A MULTIEMPLOYER WELFARE BENEFIT PLAN PROVIDING MEDICAL-HOSPITAL, DENTAL, PRESCRIPTION, VISION, LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. PART VI, LINE 11B: FORM 990 IS PRESENTED TO THE TRUSTEES FOR REVIEW AND APPROVAL. PART VI, LINE 15: THE PLAN HAS NO EMPLOYEES. MEMBERS OF THE GOVERNING BODY RECEIVE NO COMPENSATION FROM THE PLAN. PART VI, LINE 19: PLAN DOCUMENTS AND ANY OTHER GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MAINTAINED AT THE PLAN OFFICE AND ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

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