181-25 Attachment.pdf

D. ACA Annual Reporting Totals below are estimates based on quantities provided to Primepoint in the discovery process. Billing will be based on the number of unique employees paid each month. NAME RATE QTY SUBTOTAL Per 1095C • This includes employees and retiree forms. $10.00 826 $8,260.00 Total ACA Reporting Fee $8,260.00 11Document Ref: 2MTQL-THVKB-8RYDE-6Y7VF Page 11 of 30