SCHEDULE O
(Form 990)

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
UNITED FOOD AND COMMERCIAL WORKERS AND
EMPLOYERS ARIZONA HEALTH & WELFARE TRUST
Employer identification number

23-7244353
Return Reference Explanation
Part I, line 1 and part III, lines 1 and 4a: THE 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.
PART VI, LINE 11B: FORM 990 IS PRESENTED FOR REVIEW AND SIGNATURE AT the BOARD OF TRUSTEES MEETING.
PART VI, LINES 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, LINE 19: GOVERNING DOCUMENTS - NO DOCUMENTS are AVAILABLE TO THE PUbLIC. FINANCIAL STATEMENTS - AUDITED financial STATEMENTS ARE ONLY AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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