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      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
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      <RevenueSubtotalAmt>46855245</RevenueSubtotalAmt>
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      <RevenueNotReportedFinclStmtAmt>200696</RevenueNotReportedFinclStmtAmt>
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      <TotExpnsEtcAuditedFinclStmtAmt>41171148</TotExpnsEtcAuditedFinclStmtAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt XII, Line 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>ACCRUED HEALTH CLAIMS 12/31/13 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt XII, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>ACCRUED HEALTH CLAIMS 12/31/14 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION UTILIZES THE SERVICES OF I.E. SHAFFER, A TH</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>A THIRD PARTY ADMINISTRATOR, AND FABIAN &amp; BYRNE, LLC, A CL</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>CLAIMS ADMINISTRATOR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>A COPY OF THE FORM 990 IS PROVIDED TO EACH TRUSTEE AT A</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>MEETING PRIOR TO THE FILING DATE, WHERE QUESTIONS THAT A</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>TRUSTEE MAY HAVE ARE ADDRESSED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS A REGULARLY SCHEDULED QUARTERLY</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>MEETING WHERE IT MONITORS COMPLIANCE WITH THE POLICY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>NO COMPENSATION - EMPLOYEE BENEFIT PLAN.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE DOCUMENTS ARE AVAILABLE TO PARTICIPANTS AND THE PUBLIC</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24f</FormAndLineReferenceDesc>
        <ExplanationTxt>COLLECTION FEES - LEGAL 29052. 29052. 0. 0. COLLECTION FEES REIMB-102 PENSION/SURETY 22978. 22978. 0. 0. DISCOUNT CLAIM FEES 2564. 2564. 0. 0. PATIENT CENTERED OUTCOME FEE 13440. 13440. 0. 0. PAYROLL AUDIT FEES 28316. 28316. 0. 0. TRANSITIONAL REINSURANCE FEES 305879. 305879. 0. 0.</ExplanationTxt>
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</Return>