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, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE DIRECTOR OF OPERATIONS REVIEWS THE FORM 990 WITH THE TRUSTEES PRIOR TO FILING THE FORM. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONSOLIDATED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FOR SUCH INFORMATION. |
| FORM 990, PART IX, LINE 11G: | PLAN ADMINISTRATION $1,703,196 PHARMACY ADMINISTRATION 130,894 CLAIMS EDITING AND COST CONTAINMENT 535,780 CONSULTING AND ACTUARIAL 50,700 TOTAL $2,420,570 |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |