Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Pt VI, Line 10b | Form 990 reviewed by each member of the board |
| Pt VI, Line 7a | Board members have the power to elect member(s) to governing board by majority vote |
| Pt VI, Line 8b | President and members with concent of the president have authority to act on behalf of organization |
| Pt VI, Line 11b | Board members are presented with a copy of 990 during next board meeting following the filing of the return. |
| Form 990, Part IX, Line 24e | Benefits paid to participants 1746641. 1746641. |
| Form 990, Part IX, Line 24e | Reinsurance/Stop Loss fees 166634. 166634. |
| Form 990, Part IX, Line 24e | Agent fees 58708. 58708. |
| Form 990, Part IX, Line 24e | Third party admin fees 31765. 31765. |
| Form 990, Part IX, Line 24e | HRA Claims 6430. 6430. |
| Form 990, Part IX, Line 24e | PPO network access fees 4042. 4042. |
| Form 990, Part IX, Line 24e | UM fees 4460. 4460. |
| Form 990, Part IX, Line 24e | AMPS fees 31612. 31612. |
| Form 990, Part IX, Line 24e | Dues & Subscriptions 2759. 2759. |
| Software ID: | 17005306 |
| Software Version: |