Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Pt VI, Line 3 | THE ORGANIZATION UTILIZES THE SERVICES OF I.E. SHAFFER, A TH |
| Pt VI, Line 3 | A THIRD PARTY ADMINISTRATOR, AND FABIAN & BYRNE, LLC, A CL |
| Pt VI, Line 3 | CLAIMS ADMINISTRATOR. |
| Pt VI, Line 11b | A COPY OF THE FORM 990 IS PROVIDED TO EACH TRUSTEE AT A |
| Pt VI, Line 11b | MEETING PRIOR TO THE FILING DATE, WHERE QUESTIONS THAT A |
| Pt VI, Line 11b | TRUSTEE MAY HAVE ARE ADDRESSED. |
| Pt VI, Line 12c | THE ORGANIZATION HAS A REGULARLY SCHEDULED QUARTERLY |
| Pt VI, Line 12c | MEETING WHERE IT MONITORS COMPLIANCE WITH THE POLICY. |
| Pt VI, Line 15a | NO COMPENSATION - EMPLOYEE BENEFIT PLAN. |
| Pt VI, Line 19 | THE DOCUMENTS ARE AVAILABLE TO PARTICIPANTS AND THE PUBLIC |
| Pt VI, Line 19 | UPON REQUEST. |
| Form 990, Part IX, Line 24e | COLLECTION FEES - LEGAL 32692. 32692. 0. 0. |
| Form 990, Part IX, Line 24e | COLLECTION FEES REIMB-102 PENSION/SURETY 8599. 8599. 0. 0. |
| Form 990, Part IX, Line 24e | DISCOUNT CLAIM FEES 43609. 43609. 0. 0. |
| Form 990, Part IX, Line 24e | PATIENT CENTERED OUTCOME FEE 13872. 13872. 0. 0. |
| Form 990, Part IX, Line 24e | PAYROLL AUDIT FEES 56881. 56881. 0. 0. |
| Form 990, Part IX, Line 24e | TRANSITIONAL REINSURANCE FEES 209344. 209344. 0. 0. |
| Software ID: | 15000272 |
| Software Version: |