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      <TotExpensesEtcAuditedFinclStmt>37876255</TotExpensesEtcAuditedFinclStmt>
      <OtherExpensesIncluded>2364370</OtherExpensesIncluded>
      <ExpensesNotRptdF990>2364370</ExpensesNotRptdF990>
      <ExpensesSubtotal>35511885</ExpensesSubtotal>
      <InvestmentExpensesNotIncluded2>155931</InvestmentExpensesNotIncluded2>
      <OtherExpensesNotIncluded>1316939</OtherExpensesNotIncluded>
      <ExpensesNotRptdOnFinStmt>1472870</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>36984755</TotalExpensesPerForm990>
      <Form990ScheduleDPartXIV>
        <Identifier>Pt XI Line 8</Identifier>
        <Explanation>ACCRUED HEALTH CLAIMS 12/31/08 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Explanation>ACCRUED HEALTH CLAIMS 12/31/09 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>Pt XIII Line 2d</Identifier>
        <Explanation>ACCRUED HEALTH CLAIMS 12/31/08 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT</Explanation>
      </Form990ScheduleDPartXIV>
      <Form990ScheduleDPartXIV>
        <Identifier>Pt XIII Line 4b</Identifier>
        <Explanation>ACCRUED HEALTH CLAIMS 12/31/09 INCLUDED IN BENEFIT OBLIGATIONS STATEMENT</Explanation>
      </Form990ScheduleDPartXIV>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="00000003" softwareId="10000104">
      <GeneralExplanation>
        <Identifier>Pt VI-A, Line 3</Identifier>
        <Explanation>THE ORGANIZATION UTILIZES THE SERVICES OF I.E. SHAFFER,</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>A THIRD PARTY ADMINISTRATOR, AND FABIAN &amp; BYRN, LLC,</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>A CLAIMS ADMINISTRATOR.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Pt VI-B, Line 11a</Identifier>
        <Explanation>A COPY OF THE FORM 990 IS PROVIDED TO EACH TRUSTEE AT A MEETING</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>PRIOR TO THE FILING DATE, WHERE QUESTIONS THAT A TRUSTEE HAS</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>ARE ADDRESSED.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Pt VI-B, Line 12c</Identifier>
        <Explanation>THE ORGANIZATION HAS A REGULARLY SCHEDULED QUARTERLY</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>MEETING WHERE IT MONITORS COMPLIANCE WITH THE POLICY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Pt VI-B, Line 15</Identifier>
        <Explanation>NO COMPENSATION - EMPLOYEE BENEFIT PLAN</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Pt VI-C, Line 19</Identifier>
        <Explanation>THE DOCUMENTS ARE AVAILABLE TO PARTICIPANTS AND THE PUBLIC UPON REQUEST</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990EZ, Part I, Line 16</Identifier>
        <Explanation>INSURANCE CLAIMS ADMINISTRATION INSURANCE CONSULTING BANK CHARGES ACTUARY INVESTMENT ADVISORY CONSULTING OFFICE EXPENSE</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part IX, Line 24f</Identifier>
        <Explanation>PAYROLL AUDIT FEES 4918. 4918. 0. 0. INSURANCE 8157. 8157. 0. 0. PRESCRIPTION PRICING AUDIT 17000. 17000. 0. 0. COLLECTION FEES - LEGAL 37215. 37215. 0. 0. LAWSUIT JUDGMENT 136962. 136962. 0. 0.</Explanation>
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</Return>