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
INLAND EMPIRE ELECTRICAL WORKERS HEALTH
AND WELFARE PLAN
Employer identification number

91-6062784
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS HIRED A PROFESSIONAL ADMINISTRATION COMPANY TO OPERATE THE TRUST ON A DAY TO DAY BASIS. THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY OF THE ACTIONS OF THE PROFESSIONAL ADMINISTRATORS ACTIONS.
FORM 990, PART VI, SECTION A, LINE 7A MEMBERS ARE PARTICIPATING EMPLOYERS AND THE SPONSORING UNION ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B BOARD OF TRUSTEES REVIEW AND APPROVE FORM 990 BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 15A THE TRUSTEES ARE UNCOMPENSATED FOR THEIR SERVICE ON THE BOARD OF TRUSTEES. THE TRUSTEES ARE REIMBURSED FOR LOST COMPENSATION FROM THEIR EMPLOYER OR FOR LOST COMPENSABLE LEAVE UTILIZED, IF NOT PAID BY THE EMPLOYER, TO ATTEND TO TRUST BUSINESS, ATTEND TRUST MEETINGS, AND TO ATTEND TRUSTEE EDUCATIONAL TRAINING. THE TRUSTEES ARE ALSO REIMBURSED THE NECESSARY AND REASONABLE COSTS AND EXPENSES THAT THEY INCUR IN THEIR CAPACITY AS A TRUSTEE PURSUANT TO A WRITTEN TRUSTEE EXPENSE REIMBURSEMENT POLICY.
FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST
FORM 990, PART XI, LINE 9: ACCUMULATED ELIGIBILITY 6/30/16 6,805,000. ACCUMULATED ELIGIBILITY 6/30/17 -7,213,000. MANAGED CARE FEES PAYABLE 6/30/16 -57,548. PREFERRED PROVIDER AND CASE MANAGEMENT FEES -35,412.
PART XII LINE 2C THE OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
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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