Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Pt VI, Line 3 | THE ORGANIZATION UTILIZES THE SERVICES OF I.E. SHAFFER, A THIRD PARTY ADMINISTRATOR, AND FABIAN & BYRN, LLC A 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 20745. 20745. |
| Form 990, Part IX, Line 24e | COLLECTION FEES REIMB-102 PENSION/SURETY 13860. 13860. |
| Form 990, Part IX, Line 24e | PATIENT CENTERED OUTCOME FEE 15913. 15913. |
| Form 990, Part IX, Line 24e | PAYROLL AUDIT FEES 31647. 31647. |
| Software ID: | 18007482 |
| Software Version: |