SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
NORTH CAROLINA MEDICAL SOCIETY
EMPLOYEE BENEFIT TRUST
Employer identification number

56-2096193
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HIRED MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA TO MANAGE THE DAY-TO-DAY OPERATIONS PURSUANT TO A WRITTEN MANAGEMENT AGREEMENT.
FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE CHAIRMAN OF THE TRUST PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENT IS REVIEWED FOR POTENTIAL AND POSSIBLE CONFLICTS OF INTEREST AND ANY SUCH FINDING IS FORWARDED TO THE CHAIRMAN AND SPONSOR.
FORM 990, PART VI, SECTION C, LINE 19 THE TRUST'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE FILED WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE AND ARE AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9: CHANGE IN NON-ADMITTED ASSETS -821,767. EXPENSED WELLNESS GRANTS 127,500.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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