Workers' Comp P/R Audit

Self-Funded Workers' Compensation Audit

September 1 marked the anniversary of our clients' workers' comp program. A final audit of payroll is required by the plan agreement. In accordance with Section 3.5 d., "the failure to provide before October 1 accurate payroll information for the Plan year just ended to the Plan Supervisor..." constitutes a default by the Plan Sponsor. We request that you do a voluntary audit by sending the following information:

School Name:
School Representative:
Title:

Classification of Operations		Actual Payroll Period (9/1/04-8/31/05)	Number of Employees
7380	Bus Drivers Includes bus drivers	$
7422	Student Instruction Aircraft only	$
8810	Clerical Includes clerical, secretarial, receptionist, assistants, clerical bookkeeper	$
8868	Professional/Administration Includes employees not classified as bus driver, clerical or all other	$
9101	All Others Includes maintenance, cafeteria and custodial	$
Total Payroll		$

Please complete the above information and submit by September 17, 2005. Claims Administrative Services, Inc. appreciates having the opportunity of being your service provider. Please call Customer Service at
(800) 765-2412 if you have any questions.

Thank you for your prompt response. We appreciate your business.