Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 REVIEW BY TRUSTEES & PLAN ADMINISTRATOR WITH CPA PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD OF TRUSTEES MONITOR POTENTIAL CONFLICTS OF INTEREST AT QUARTERLY BOARD MEETINGS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | REVIEWED ANNUALLY BY TRUSTEES. |
| FORM 990, PAGE 6, PART VI, LINE 15B | REVIEWED ANNUALLY BY THE TRUSTEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | ACTUARY 10,322 0 0 INSURANCE CONSULTANT 24,900 0 0 TPA FEES 192,641 0 0 PPO PREMIUMS 21,368 0 0 STOP LOSS PREMIUMS 634,595 0 0 LIFE INSURANCE PREMIUMS 133,671 0 0 DISEASE MANAGEMENT PROGRAM 33,044 0 0 HEALTHFAIR EXPENSE 14,532 0 0 SPOUSE PREMIUM REIMBURSED 27,899 0 0 MEMBERSHIP DUES 1,760 0 0 RECIPROCITY EXPENSE 1,367,569 0 0 ACA FEE 91,613 0 0 |
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