4 Reporting
4.14 Supplementary and Other Information
4.14.2 DES Schedule of Expenses – Risk Pools
This requirement applies only to risk pools.
DES Schedule of Expenses
__________________________________
(Pool)
For the Fiscal Year Ended , 20__
|
Insurance Members | $_____ | |
|
Contracted Services: | ||
| Third Party Administrator Fees | ______ | |
| Actuarial | ______ | |
| Audit Expenses | ______ | |
| Brokerage Fees | ______ | |
| Legal Fees | ______ | |
| Other Consultant Fees | ______ | |
| General Administrative Expenses: | ||
| Communication | ______ | |
| Supplies | ______ | |
| Dues and Conferences | ______ | |
| Retreat/Board Meetings | ______ | |
| Training | ______ | |
| Depreciation | ______ | |
| Miscellaneous | ______ | |
| Other | ||
| ______ | ||
| Total Operating Expenses | $_____ |