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 8a | Monthly reviews of financials & budgets; periodic and annual reviews; and meetings with administratiors and auditors are not recorded. |
| Pt VI, Line 8b | Monthly reviews of financials & budgets; periodic and annual reviews; and meetings with administrators and auditors are not recorded. |
| Pt VI, Line 11b | The compiled and annual audited financial statements are reviewed by the trustees. Then the financials' relation with part VIII, IX, & X are reviewed for accuracy and any questions are resolved. After the above, all answers to questions in parts I,III,IV,VI,VII,XI, and schedules L. R and answers on schedule O are reviewed for accuracy. |
| Pt VI, Line 15a | The trust (or any related organizations) does not compensate its trustees for their activities. |
| Pt VI, Line 15b | The trust (or any related organizations) does not compensate its trustees for their activities. |
| Pt VI, Line 19 | Governing documents, financial statements, as well as other related documents are available to the public upon request at its offices (1 Commercial Drive) during normal business hours. |
| Pt XII, Line 2c | No: The trustees assume the responsibility for oversight of the compilation and audit of its financial statements and the selection of the CPA/Auditor. |
| Form 990, Part IX, Line 24e | Participant Dental Claims 39228. 39228. 0. 0. |
| Form 990, Part IX, Line 24e | Participant Vision Claims 1570. 1570. 0. 0. |
| Form 990, Part IX, Line 24e | Prescription Claims Paid 159626. 159626. 0. 0. |
| Form 990, Part IX, Line 24e | HSA HDHP Contribution 14250. 14250. 0. 0. |
| Form 990, Part IX, Line 24e | Participant Group Life Premiums 6570. 6570. 0. 0. |
| Form 990, Part IX, Line 24e | Participant ST Disability Premiums 9953. 9953. 0. 0. |
| Form 990, Part IX, Line 24e | Optional Group Premiums 24233. 24233. 0. 0. |
| Form 990, Part IX, Line 24e | ACA Trans Reinsurance Fees 5470. 5470. 0. 0. |
| Form 990, Part IX, Line 24e | Patient-Centered Outcomes Fees 294. 294. 0. 0. |
| Form 990, Part IX, Line 24e | Certified Audit 12250. 12250. 0. 0. |
| Form 990, Part IX, Line 24e | Compiled Statements & Form 990 4500. 4500. 0. 0. |
| Software ID: | 15000272 |
| Software Version: |