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
2016
Open to Public
Inspection
Name of the organization
GRACEWORKS LUTHERAN SERVICES HEALTH
BENEFIT TRUST
Employer identification number

31-1273785
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 8A THE ORGANIZATION DOES NOT HOLD MEETINGS OF THE GOVERNING BODY AND THEREFORE IT HAS NOT DOCUMENTED SUCH MEETINGS.
FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HOLD MEETINGS OF THE GOVERNING BODY AND THEREFORE IT HAS NOT DOCUMENTED SUCH MEETINGS.
FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO EACH VOTING MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION PRIOR TO THE TIME OF FILING FORM 990. EACH VOTING MEMBER IS GIVEN THE OPPORTUNITY TO REVIEW AND COMMENT ON THE FORM.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST, AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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