Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| 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 52634. 52634. 0. 0. |
| Form 990, Part IX, Line 24e | Participant Vision Claims 1430. 1430. 0. 0. |
| Form 990, Part IX, Line 24e | Prescription Claims Paid 385969. 385969. 0. 0. |
| Form 990, Part IX, Line 24e | HSA HDHP Contribution 12960. 12960. 0. 0. |
| Form 990, Part IX, Line 24e | Participant Group Life Premiums 6548. 6548. 0. 0. |
| Form 990, Part IX, Line 24e | Participant ST Disability Premiums 10741. 10741. 0. 0. |
| Form 990, Part IX, Line 24e | Optional Group Premiums 43362. 43362. 0. 0. |
| Form 990, Part IX, Line 24e | ACA Trans Reinsurance Fees 170. 170. 0. 0. |
| Form 990, Part IX, Line 24e | Patient-Centered Outcomes Fees 755. 755. 0. 0. |
| Form 990, Part IX, Line 24e | Certified Audit 8000. 8000. 0. 0. |
| Form 990, Part IX, Line 24e | Compiled Statements & Form 990 4500. 4500. 0. 0. |
| Form 990, Part IX, Line 24e | Form 5500 preparation 1200. 1200. 0. 0. |
| Form 990, Part IX, Line 24e | HSA Service Charges 1770. 1770. 0. 0. |
| Software ID: | 18007482 |
| Software Version: |