Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4d | Vision Expenses-Covers various expenses relating to preventing and diagnostic treatment: Expense $116,458, Stop Loss Premium-Reinsurance contract on large medical claims: $351,860, Employee Assistance, Personal Assessment and Counseling Services: $13,049 |
| Form 990, Part VI, Section A, Line 7a | Directors of the Trustee are elected by policyholder/members, as trustee is a mutual insurer. |
| Form 990, Part VI, Section B, Line 11b | Completed 990 is reviewed by member of governing board with financial knowledge on behalf of all members. |
| Form 990, Part VI, Section B, Line 12c | Annual Conflict of Interest declaration forms are required. |
| Form 990, Part VI, Section C, Line 19 | Summarized financial statements are provided to trust beneficiaries annually. Governing documents, conflict of interest and more detailed financial information is available upon request. |
| Software ID: | 18007995 |
| Software Version: | v1.00 |