401k Plan data: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN plan

WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN
Plan identification number	501

WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

WEST COAST PRIME MEATS, LLC has sponsored the creation of one or more 401k plans.

Company Name: WEST COAST PRIME MEATS, LLC

Employer identification number (EIN): 274172943

NAIC Classification: 311610
NAIC Description: Animal Slaughtering and Processing

Additional information about WEST COAST PRIME MEATS, LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 201034810022

More information about WEST COAST PRIME MEATS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-03-01
501 2020-03-01
501 2019-03-01
501 2018-03-01
501 2017-03-01 NATHAN BENNETT
501 2016-03-01 NATHAN BENNETT
501 2015-03-01 NATHAN BENNETT
501 2014-03-01 NATHAN BENNETT
501 2013-03-01 NATHAN BENNETT

Plan Statistics for WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN

Measure Date Value
2021: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 160
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 140
Total of all active and inactive participants 2021-03-01 140
Total participants 2021-03-01 140
2020: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 213
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 160
Total of all active and inactive participants 2020-03-01 160
Total participants 2020-03-01 160
2019: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-03-01 211
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 213
Total of all active and inactive participants 2019-03-01 213
Total participants 2019-03-01 213
2018: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-03-01 150
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 211
Total of all active and inactive participants 2018-03-01 211
Total participants 2018-03-01 211
2017: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-03-01 136
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 150
Total of all active and inactive participants 2017-03-01 150
Total participants 2017-03-01 150
2016: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-03-01 125
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 136
Total of all active and inactive participants 2016-03-01 136
Total participants 2016-03-01 136
2015: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 125
Total of all active and inactive participants 2015-03-01 125
Total participants 2015-03-01 0
2014: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-01 111
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 112
Total of all active and inactive participants 2014-03-01 112
Total participants 2014-03-01 0
2013: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 108
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 111
Total of all active and inactive participants 2013-03-01 111
Total participants 2013-03-01 0

Measure	Date	Value
2021: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	160
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	140
Total of all active and inactive participants	2021-03-01	140
Total participants	2021-03-01	140
2020: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	213
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	160
Total of all active and inactive participants	2020-03-01	160
Total participants	2020-03-01	160
2019: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-03-01	211
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	213
Total of all active and inactive participants	2019-03-01	213
Total participants	2019-03-01	213
2018: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-03-01	150
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	211
Total of all active and inactive participants	2018-03-01	211
Total participants	2018-03-01	211
2017: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-03-01	136
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	150
Total of all active and inactive participants	2017-03-01	150
Total participants	2017-03-01	150
2016: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-03-01	125
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	136
Total of all active and inactive participants	2016-03-01	136
Total participants	2016-03-01	136
2015: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	125
Total of all active and inactive participants	2015-03-01	125
Total participants	2015-03-01	0
2014: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-01	111
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	112
Total of all active and inactive participants	2014-03-01	112
Total participants	2014-03-01	0
2013: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	108
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	111
Total of all active and inactive participants	2013-03-01	111
Total participants	2013-03-01	0

Form 5500 Responses for WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN

2021: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2020: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2019: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2018: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2017: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes
2016: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-03-01	Type of plan entity	Single employer plan
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes
2015: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2014: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes
2013: WEST COAST PRIME MEATS, LLC WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	First time form 5500 has been submitted	Yes
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $1,638
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $11,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,638
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	111
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $7,658
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,658
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $867
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $867
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $807
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $9,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $807
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $1,443
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,443
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $358
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $1,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $358
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

233051

Policy instance

Insurance contract or identification number	233051
Number of Individuals Covered	76
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $18,491
Welfare Benefit Premiums Paid to Carrier	USD $406,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,491
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

926831

Policy instance

Insurance contract or identification number	926831
Number of Individuals Covered	140
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $952
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $952
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

171912

Policy instance

Insurance contract or identification number	171912
Number of Individuals Covered	97
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $44,825
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $900,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,806
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	32
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $1,482
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $9,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,482
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	90
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $5,995
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,995
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	15
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $814
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $814
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	129
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $820
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $8,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $820
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	62
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $1,193
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,193
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998251

Policy instance

Insurance contract or identification number	4998251
Number of Individuals Covered	5
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of fees paid to insurance company	USD $297
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $1,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	297
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

233051

Policy instance

Insurance contract or identification number	233051
Number of Individuals Covered	38
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $17,101
Welfare Benefit Premiums Paid to Carrier	USD $339,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,101
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	23
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $1,103
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $5,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,103
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

171912

Policy instance

Insurance contract or identification number	171912
Number of Individuals Covered	87
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $31,932
Total amount of fees paid to insurance company	USD $17,218
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $572,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,437
Insurance broker organization code?	3
Amount paid for insurance broker fees	17218
Additional information about fees paid to insurance broker	BONUS

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	33
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $1,299
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $7,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,299
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

233051

Policy instance

Insurance contract or identification number	233051
Number of Individuals Covered	49
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $21,938
Welfare Benefit Premiums Paid to Carrier	USD $407,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,938
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998251

Policy instance

Insurance contract or identification number	4998251
Number of Individuals Covered	7
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $311
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $1,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $311
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	133
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-28
Total amount of commissions paid to insurance broker	USD $7,192
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,192
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	22
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $803
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $803
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	116
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $1,799
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,799
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

282277

Policy instance

Insurance contract or identification number	282277
Number of Individuals Covered	123
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $39,008
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $832,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,008
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	36
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $1,300
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $9,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,300
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	213
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-29
Total amount of commissions paid to insurance broker	USD $1,192
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $11,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,192
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L5639A

Policy instance

Insurance contract or identification number	L5639A
Number of Individuals Covered	116
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $35,428
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $813,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,428
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	33
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $1,234
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $7,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,234
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	133
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $743
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $7,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $743
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	88
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $1,420
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,420

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998251

Policy instance

Insurance contract or identification number	4998251
Number of Individuals Covered	3
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $138
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $5,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

233051

Policy instance

Insurance contract or identification number	233051
Number of Individuals Covered	35
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $16,451
Total amount of fees paid to insurance company	USD $1,157
Welfare Benefit Premiums Paid to Carrier	USD $334,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,451
Amount paid for insurance broker fees	1157
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	23
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $1,082
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $5,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,082
Insurance broker organization code?	3

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	22
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $912
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $912
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	120
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $5,156
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,156
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L5639A

Policy instance

Insurance contract or identification number	L5639A
Number of Individuals Covered	115
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $36,726
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $738,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,726
Insurance broker organization code?	3
Insurance broker name	KIMBERLY GILMOUR BOWSER

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	112
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of fees paid to insurance company	USD $4,355
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4355
Insurance broker organization code?	3
Insurance broker name	J.D. GILMOUR & CO., INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	23
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of fees paid to insurance company	USD $1,004
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1004
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	29
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of fees paid to insurance company	USD $1,437
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $9,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1437
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	150
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $886
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $8,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $886
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	75
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $1,349
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,349
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998251

Policy instance

Insurance contract or identification number	4998251
Number of Individuals Covered	3
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of fees paid to insurance company	USD $207
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	207
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

233051

Policy instance

Insurance contract or identification number	233051
Number of Individuals Covered	39
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $14,499
Total amount of fees paid to insurance company	USD $1
Welfare Benefit Premiums Paid to Carrier	USD $296,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,499
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	VALUE OF NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BENEFITS AMERICA INSURANCE SERVICES

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	21
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $849
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $849
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L5639A

Policy instance

Insurance contract or identification number	L5639A
Number of Individuals Covered	120
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $36,962
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $740,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,962
Insurance broker organization code?	3
Insurance broker name	KIMBERLY GILMOUR BOWSER

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	100
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $3,675
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,675
Insurance broker organization code?	3
Insurance broker name	J.D. GILMOUR & CO., INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	18
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $1,441
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $8,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,441
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	17
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $983
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $4,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $983
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	125
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $676
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $6,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $676
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	26
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $1,314
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,314
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998251

Policy instance

Insurance contract or identification number	4998251
Number of Individuals Covered	9
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $670
Other welfare benefits provided	CANCER BENEFIT
Welfare Benefit Premiums Paid to Carrier	USD $2,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $670
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	59
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $1,040
Total amount of fees paid to insurance company	USD $17
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,040
Insurance broker organization code?	3
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker name	J.D. GILMOUR & CO., INC.

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L5639A

Policy instance

Insurance contract or identification number	L5639A
Number of Individuals Covered	117
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $34,323
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $689,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,323
Insurance broker organization code?	3
Insurance broker name	KIMBERLY GILMOUR BOWSER

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	51
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,989
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,989
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	36
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,438
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $8,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,438
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	26
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,328
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,328
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	95
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $2,880
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,880
Insurance broker organization code?	3
Insurance broker name	J.D. GILMOUR & CO., INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	51
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $937
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $937
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	112
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $428
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $4,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $428
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L5639A

Policy instance

Insurance contract or identification number	L5639A
Number of Individuals Covered	111
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $28,085
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $616,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,085
Insurance broker organization code?	3
Insurance broker name	KIMBERLY GILMOUR BOWSER

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	58
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,059
Total amount of fees paid to insurance company	USD $32
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,059
Insurance broker organization code?	3
Amount paid for insurance broker fees	32
Additional information about fees paid to insurance broker	FMV NON MONETARY COMPENSATION
Insurance broker name	J.D. GILMOUR & CO., INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4998990

Policy instance

Insurance contract or identification number	4998990
Number of Individuals Covered	29
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,294
Total amount of fees paid to insurance company	USD $21
Other welfare benefits provided	ACCIDENT INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,294
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	FMV NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

4053779

Policy instance

Insurance contract or identification number	4053779
Number of Individuals Covered	35
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,120
Total amount of fees paid to insurance company	USD $14
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,120
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	FMV NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

1159

Policy instance

Insurance contract or identification number	1159
Number of Individuals Covered	59
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,965
Total amount of fees paid to insurance company	USD $22
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,965
Amount paid for insurance broker fees	22
Additional information about fees paid to insurance broker	FMV NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ANDREW D. GILMOUR, INC.

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

14723

Policy instance

Insurance contract or identification number	14723
Number of Individuals Covered	94
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $2,309
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,721
Insurance broker organization code?	3
Insurance broker name	J.D. GILMOUR & CO., INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5462464

Policy instance

Insurance contract or identification number	5462464
Number of Individuals Covered	100
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $338
Total amount of fees paid to insurance company	USD $10
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $3,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $338
Insurance broker organization code?	3
Amount paid for insurance broker fees	10
Additional information about fees paid to insurance broker	FMV NON MONETARY COMPENSATION
Insurance broker name	J.D. GILMOUR & CO., INC.

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Company Name:	WEST COAST PRIME MEATS, LLC
Employer identification number (EIN):	274172943
NAIC Classification:	311610
NAIC Description:	Animal Slaughtering and Processing

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	201034810022