**IMPORTANT NOTICE** ALL QUARTERLY WORKERS’ COMPENSATION AUDIT FORMS ARE DUE BY THE 10TH OF FOLLOWING CORRESPONDING MONTH.

QUARTERLY INFORMATION FOR: APRIL – JUNE , WILL BE DUE ON JULY 10 JULY – SEPTEMBER , WILL BE DUE ON OCTOBER 10 OCTOBER – DECEMBER , WILL BE DUE ON JANUARY 10 JANUARY – MARCH , WILL BE DUE ON APRIL 10

THE WORKERS’ COMPENSATION AUDIT FORMS AND INSTRUCTIONS CAN BE FOUND ON OUR WEBSITE www.foursquare.org/insurance scroll down to Workers’ Compensation. Please mail to: Foursquare Insurance Department PO Box 26902, Los Angeles, CA 90026-0176 FAX: 213-989-4531 Or scan and email to: [email protected]

Revised 2-10-16 Foursquare Insurance Department