Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990EZ, Part I, Line 16 | State Insurance Dept. Fees 25. |
| Form 990EZ, Part II, Line 24 | Premiums receivable 145. 0. |
| Form 990EZ, Part II, Line 26 | Benefit claims unpaid 500. 150. |
| Software ID: | 18007482 |
| Software Version: |