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-EZ, Part I, Line 4 - Other Investment Income | Description: Dividend income. Amount: 1,765. |
| Form 990-EZ, Part I, Line 16 - Other Expenses | Description: Insurance premiums - Health. Amount: 77,214. Description: Insurance premiums - Dental. Amount: 5,419. Description: Insurance premiums - Disability. Amount: 3,461. Description: Insurance premiums - Life. Amount: 814. Description: Insurance premiums - Vision. Amount: 444. Description: Healthcare reimbursements. Amount: 4,721. Description: Plan operating costs. Amount: 323. Total to Form 990-EZ, line 16: 92,396. |
| Form 990-EZ, Part I, Line 20 - Other Changes in Net Assets | Description: Unrealized investment holding gains/losses. Amount: -22,924. |
| Form 990-EZ, Part II, Line 26 - Other Liabilities | Description: Accounts payable. Beg. of Year Amount: 29,117. End of Year Amount: 100. |
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