HELIX ELECTRIC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	HELIX ELECTRIC HEALTH AND WELFARE PLAN
Plan identification number	504

HELIX ELECTRIC HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

HELIX ELECTRIC, INC. has sponsored the creation of one or more 401k plans.

Company Name:	HELIX ELECTRIC, INC.
Employer identification number (EIN):	330124909
NAIC Classification:	238210
NAIC Description:	Electrical Contractors and Other Wiring Installation Contractors

Additional information about HELIX ELECTRIC, INC.

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1995-11-22
Company Identification Number:	0010735306
Legal Registered Office Address:	PO BOX 85298 SAN DIEGO United States of America (USA) 92186

More information about HELIX ELECTRIC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HELIX ELECTRIC HEALTH AND WELFARE PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01	MICHAEL STONE	2023-10-09
504	2021-01-01	MICHAEL STONE	2022-10-14
504	2021-01-01	MICHAEL STONE	2022-10-14
504	2020-01-01	JENNIFER LESKO	2021-10-14
504	2019-01-01	MICHAEL STONE	2020-10-13
504	2018-01-01	MICHAEL STONE	2019-10-11
504	2018-01-01	MICHAEL STONE	2019-10-23
504	2017-01-01
504	2016-01-01
504	2015-01-01
504	2014-01-01
504	2013-01-01
504	2012-01-01	MICHAEL STONE
504	2011-01-01	MICHAEL STONE
504	2010-01-01	MICHAEL STONE
504	2009-01-01	MICHAEL STONE
504	2009-01-01	MICHAEL STONE
504	2009-01-01	MICHAEL STONE

Plan Statistics for HELIX ELECTRIC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for HELIX ELECTRIC HEALTH AND WELFARE PLAN

Measure	Date	Value
2022: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,933
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,354
Total of all active and inactive participants	2022-01-01	3,354
2021: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	945
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,933
Total of all active and inactive participants	2021-01-01	1,933
2020: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,197
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	945
Total of all active and inactive participants	2020-01-01	945
2019: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,722
Number of retired or separated participants receiving benefits	2019-01-01	2,197
Total of all active and inactive participants	2019-01-01	2,197
2018: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,090
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,722
Total of all active and inactive participants	2018-01-01	1,722
2017: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,075
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,090
Total of all active and inactive participants	2017-01-01	3,090
2016: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,659
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,075
Total of all active and inactive participants	2016-01-01	2,075
2015: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,409
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,659
Total of all active and inactive participants	2015-01-01	1,659
2014: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,070
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,409
Total of all active and inactive participants	2014-01-01	1,409
2013: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,162
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,070
Total of all active and inactive participants	2013-01-01	1,070
2012: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	843
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,162
Total of all active and inactive participants	2012-01-01	1,162
2011: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	953
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	843
Total of all active and inactive participants	2011-01-01	843
2010: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	829
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	953
Total of all active and inactive participants	2010-01-01	953
2009: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,204
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	829
Total of all active and inactive participants	2009-01-01	829

Financial Data on HELIX ELECTRIC HEALTH AND WELFARE PLAN

Measure	Date	Value
2022 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$721,481
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$53,676
Total income from all sources (including contributions)	2022-12-31	$20,660,703
Total of all expenses incurred	2022-12-31	$19,834,079
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$19,620,518
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$20,660,703
Value of total assets at end of year	2022-12-31	$3,534,033
Value of total assets at beginning of year	2022-12-31	$2,039,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$213,561
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$5,984,189
Participant contributions at end of year	2022-12-31	$377,286
Participant contributions at beginning of year	2022-12-31	$579,014
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$7,000
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$1,754,169
Administrative expenses (other) incurred	2022-12-31	$213,561
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$826,624
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$2,812,552
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,985,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$2,077,700
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$534,506
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$534,506
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$1,103,947
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$14,676,514
Employer contributions (assets) at end of year	2022-12-31	$1,072,047
Employer contributions (assets) at beginning of year	2022-12-31	$919,084
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$16,762,402
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$721,481
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$53,676
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MOSS ADAMS
Accountancy firm EIN	2022-12-31	950189318
2021 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$53,676
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$53,676
Total income from all sources (including contributions)	2021-12-31	$20,413,301
Total of all expenses incurred	2021-12-31	$20,309,512
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$20,247,036
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$20,413,301
Value of total assets at end of year	2021-12-31	$2,039,604
Value of total assets at beginning of year	2021-12-31	$1,935,815
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$62,476
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$32,142
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$6,561,592
Participant contributions at end of year	2021-12-31	$579,014
Participant contributions at beginning of year	2021-12-31	$612,745
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$4,962
Administrative expenses (other) incurred	2021-12-31	$23,009
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$103,789
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,985,928
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,882,139
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$7,325
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$534,506
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$397,331
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$397,331
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$17,267,931
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$13,851,709
Employer contributions (assets) at end of year	2021-12-31	$919,084
Employer contributions (assets) at beginning of year	2021-12-31	$913,777
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$2,979,105
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$53,676
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$53,676
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MOSS ADAMS
Accountancy firm EIN	2021-12-31	950189318
2020 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$53,676
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$53,676
Total income from all sources (including contributions)	2020-12-31	$18,131,290
Total of all expenses incurred	2020-12-31	$17,663,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$17,608,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$18,130,568
Value of total assets at end of year	2020-12-31	$2,205,552
Value of total assets at beginning of year	2020-12-31	$1,737,623
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$55,045
Total interest from all sources	2020-12-31	$722
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$33,306
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$6,692,282
Participant contributions at end of year	2020-12-31	$623,848
Participant contributions at beginning of year	2020-12-31	$274,211
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$4,962
Administrative expenses (other) incurred	2020-12-31	$16,139
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$467,929
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,151,876
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,683,947
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$5,600
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$397,331
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$983,457
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$983,457
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$722
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$16,738,255
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$11,438,286
Employer contributions (assets) at end of year	2020-12-31	$1,172,411
Employer contributions (assets) at beginning of year	2020-12-31	$467,993
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$870,061
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$53,676
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$53,676
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MOSS ADAMS
Accountancy firm EIN	2020-12-31	950189318
2019 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$53,676
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$53,676
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$117,166
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$117,166
Total income from all sources (including contributions)	2019-12-31	$16,282,417
Total income from all sources (including contributions)	2019-12-31	$16,282,417
Total of all expenses incurred	2019-12-31	$15,774,106
Total of all expenses incurred	2019-12-31	$15,774,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$15,710,734
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$15,710,734
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$16,196,896
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$16,196,896
Value of total assets at end of year	2019-12-31	$1,265,156
Value of total assets at end of year	2019-12-31	$1,265,156
Value of total assets at beginning of year	2019-12-31	$820,335
Value of total assets at beginning of year	2019-12-31	$820,335
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$63,372
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$63,372
Total interest from all sources	2019-12-31	$5,274
Total interest from all sources	2019-12-31	$5,274
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$40,189
Administrative expenses professional fees incurred	2019-12-31	$40,189
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$5,430,558
Contributions received from participants	2019-12-31	$5,430,558
Participant contributions at end of year	2019-12-31	$11,103
Participant contributions at end of year	2019-12-31	$11,103
Participant contributions at beginning of year	2019-12-31	$96,484
Participant contributions at beginning of year	2019-12-31	$96,484
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$7,000
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$4,962
Other income not declared elsewhere	2019-12-31	$80,247
Other income not declared elsewhere	2019-12-31	$80,247
Administrative expenses (other) incurred	2019-12-31	$18,184
Administrative expenses (other) incurred	2019-12-31	$18,184
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$508,311
Value of net income/loss	2019-12-31	$508,311
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,211,480
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,211,480
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$703,169
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$703,169
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$4,999
Investment advisory and management fees	2019-12-31	$4,999
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$983,457
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$983,457
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$590,035
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$590,035
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$590,035
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$590,035
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$5,274
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$5,274
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$14,699,654
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$14,699,654
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$10,766,338
Contributions received in cash from employer	2019-12-31	$10,766,338
Employer contributions (assets) at end of year	2019-12-31	$258,634
Employer contributions (assets) at end of year	2019-12-31	$258,634
Employer contributions (assets) at beginning of year	2019-12-31	$121,854
Employer contributions (assets) at beginning of year	2019-12-31	$121,854
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,011,080
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,011,080
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$53,676
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$53,676
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$117,166
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$117,166
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	MOSS ADAMS
Accountancy firm name	2019-12-31	MOSS ADAMS
Accountancy firm EIN	2019-12-31	950189318
Accountancy firm EIN	2019-12-31	950189318
2018 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$117,166
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$173,244
Total income from all sources (including contributions)	2018-12-31	$15,116,773
Total of all expenses incurred	2018-12-31	$15,662,795
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$15,611,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$15,113,365
Value of total assets at end of year	2018-12-31	$820,335
Value of total assets at beginning of year	2018-12-31	$1,422,435
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$51,533
Total interest from all sources	2018-12-31	$3,408
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$35,275
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$4,780,083
Participant contributions at end of year	2018-12-31	$96,484
Participant contributions at beginning of year	2018-12-31	$88,634
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$7,000
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$171,685
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$4,962
Administrative expenses (other) incurred	2018-12-31	$10,826
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-546,022
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$703,169
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,249,191
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$5,432
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$590,035
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$1,166,003
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$1,166,003
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$3,408
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$15,667,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$10,161,597
Employer contributions (assets) at end of year	2018-12-31	$121,854
Employer contributions (assets) at beginning of year	2018-12-31	$155,836
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$-56,078
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$117,166
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$173,244
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	MOSS ADAMS
Accountancy firm EIN	2018-12-31	950189318
2017 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$173,244
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$77,120
Total income from all sources (including contributions)	2017-12-31	$15,629,326
Total of all expenses incurred	2017-12-31	$15,710,462
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$15,667,322
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$15,627,482
Value of total assets at end of year	2017-12-31	$1,422,435
Value of total assets at beginning of year	2017-12-31	$1,407,447
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$43,140
Total interest from all sources	2017-12-31	$1,844
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$22,300
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$4,391,213
Participant contributions at end of year	2017-12-31	$88,634
Participant contributions at beginning of year	2017-12-31	$332,423
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$4,962
Administrative expenses (other) incurred	2017-12-31	$15,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-81,136
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,249,191
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,330,327
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$5,340
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$1,166,003
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$42,781
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$42,781
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$1,844
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$13,665,978
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$11,236,269
Employer contributions (assets) at end of year	2017-12-31	$155,836
Employer contributions (assets) at beginning of year	2017-12-31	$1,020,281
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,001,344
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$173,244
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$77,120
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	MOSS ADAMS
Accountancy firm EIN	2017-12-31	950189318
2016 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$77,120
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$47,158
Total income from all sources (including contributions)	2016-12-31	$13,238,242
Total of all expenses incurred	2016-12-31	$13,146,074
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$13,070,028
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$13,237,636
Value of total assets at end of year	2016-12-31	$1,407,447
Value of total assets at beginning of year	2016-12-31	$1,285,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$76,046
Total interest from all sources	2016-12-31	$606
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$9,222
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$3,557,705
Participant contributions at end of year	2016-12-31	$332,423
Participant contributions at beginning of year	2016-12-31	$312,799
Assets. Other investments not covered elsewhere at end of year	2016-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2016-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$4,962
Administrative expenses (other) incurred	2016-12-31	$60,380
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$92,168
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,330,327
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,238,159
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$6,444
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$42,781
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$211,842
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$211,842
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$606
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$12,123,582
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$9,679,931
Employer contributions (assets) at end of year	2016-12-31	$1,020,281
Employer contributions (assets) at beginning of year	2016-12-31	$748,714
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$946,446
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$77,120
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$47,158
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	MOSS ADAMS
Accountancy firm EIN	2016-12-31	950189318
2015 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$47,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$13,746
Total income from all sources (including contributions)	2015-12-31	$10,529,024
Total of all expenses incurred	2015-12-31	$10,617,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$10,538,673
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$10,528,588
Value of total assets at end of year	2015-12-31	$1,285,317
Value of total assets at beginning of year	2015-12-31	$1,340,168
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$78,614
Total interest from all sources	2015-12-31	$436
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$24,700
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$3,167,272
Participant contributions at end of year	2015-12-31	$312,799
Participant contributions at beginning of year	2015-12-31	$287,397
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$4,962
Administrative expenses (other) incurred	2015-12-31	$49,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-88,263
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,238,159
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,326,422
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$4,914
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$211,842
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$376,747
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$376,747
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$436
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$9,263,864
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$7,361,316
Employer contributions (assets) at end of year	2015-12-31	$748,714
Employer contributions (assets) at beginning of year	2015-12-31	$664,062
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,274,809
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$47,158
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$13,746
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	MOSS ADAMS
Accountancy firm EIN	2015-12-31	950189318
2014 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$13,746
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$13,627
Total income from all sources (including contributions)	2014-12-31	$9,632,409
Total of all expenses incurred	2014-12-31	$9,613,184
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$9,565,509
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$9,632,048
Value of total assets at end of year	2014-12-31	$1,340,168
Value of total assets at beginning of year	2014-12-31	$1,320,824
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$47,675
Total interest from all sources	2014-12-31	$361
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$10,154
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$3,090,574
Participant contributions at end of year	2014-12-31	$287,397
Participant contributions at beginning of year	2014-12-31	$163,652
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$4,962
Administrative expenses (other) incurred	2014-12-31	$36,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$19,225
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,326,422
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,307,197
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$1,521
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$376,747
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$846,371
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$846,371
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$361
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$8,766,487
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$6,541,474
Employer contributions (assets) at end of year	2014-12-31	$664,062
Employer contributions (assets) at beginning of year	2014-12-31	$298,839
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$799,022
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$13,746
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$13,627
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	MOSS ADAMS
Accountancy firm EIN	2014-12-31	950189318
2013 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$13,627
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$36,024
Total income from all sources (including contributions)	2013-12-31	$7,361,407
Total of all expenses incurred	2013-12-31	$8,109,447
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$8,060,480
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$7,360,982
Value of total assets at end of year	2013-12-31	$1,320,824
Value of total assets at beginning of year	2013-12-31	$2,091,261
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$48,967
Total interest from all sources	2013-12-31	$425
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$11,436
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$2,824,593
Participant contributions at end of year	2013-12-31	$163,652
Participant contributions at beginning of year	2013-12-31	$203,882
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$4,962
Administrative expenses (other) incurred	2013-12-31	$36,010
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-748,040
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,307,197
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,055,237
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$1,521
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$846,371
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$1,520,404
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$1,520,404
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$425
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$7,216,725
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$4,536,389
Employer contributions (assets) at end of year	2013-12-31	$298,839
Employer contributions (assets) at beginning of year	2013-12-31	$355,013
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$843,755
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$13,627
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$36,024
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	MOSS ADAMS
Accountancy firm EIN	2013-12-31	950189318
2012 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$36,024
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$36,960
Total income from all sources (including contributions)	2012-12-31	$7,215,749
Total of all expenses incurred	2012-12-31	$7,263,527
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$7,207,408
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$7,215,580
Value of total assets at end of year	2012-12-31	$2,091,261
Value of total assets at beginning of year	2012-12-31	$2,139,975
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$56,119
Total interest from all sources	2012-12-31	$169
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$20,109
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$2,616,340
Participant contributions at end of year	2012-12-31	$203,882
Participant contributions at beginning of year	2012-12-31	$163,591
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$4,962
Administrative expenses (other) incurred	2012-12-31	$36,010
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-47,778
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,055,237
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,103,015
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$1,520,404
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$1,672,502
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$1,672,502
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$169
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$6,453,100
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$4,599,240
Employer contributions (assets) at end of year	2012-12-31	$355,013
Employer contributions (assets) at beginning of year	2012-12-31	$291,920
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$754,308
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$36,024
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$36,960
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MOSS ADAMS
Accountancy firm EIN	2012-12-31	950189318
2011 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$36,960
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$30,193
Total income from all sources (including contributions)	2011-12-31	$5,556,519
Total of all expenses incurred	2011-12-31	$5,656,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$5,599,092
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$5,556,342
Value of total assets at end of year	2011-12-31	$2,139,975
Value of total assets at beginning of year	2011-12-31	$2,233,612
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$57,831
Total interest from all sources	2011-12-31	$177
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$20,611
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$2,194,940
Participant contributions at end of year	2011-12-31	$163,591
Participant contributions at beginning of year	2011-12-31	$235,015
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$4,962
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$6,528
Administrative expenses (other) incurred	2011-12-31	$37,220
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-100,404
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,103,015
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,203,419
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$1,672,502
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$1,662,128
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$1,662,128
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$177
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$4,971,457
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$3,361,402
Employer contributions (assets) at end of year	2011-12-31	$291,920
Employer contributions (assets) at beginning of year	2011-12-31	$322,941
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$627,635
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$36,960
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$30,193
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MOSS ADAMS
Accountancy firm EIN	2011-12-31	910189318
2010 : HELIX ELECTRIC HEALTH AND WELFARE PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$30,193
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$45,671
Total income from all sources (including contributions)	2010-12-31	$5,564,115
Total of all expenses incurred	2010-12-31	$5,408,174
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$5,289,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$5,563,513
Value of total assets at end of year	2010-12-31	$2,233,612
Value of total assets at beginning of year	2010-12-31	$2,093,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$118,811
Total interest from all sources	2010-12-31	$602
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$38,404
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$2,051,783
Participant contributions at end of year	2010-12-31	$235,015
Participant contributions at beginning of year	2010-12-31	$174,959
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$7,000
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$7,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$6,528
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$7,638
Administrative expenses (other) incurred	2010-12-31	$37,537
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$155,941
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,203,419
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,047,478
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$1,662,128
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$1,630,907
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$1,630,907
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$602
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$4,644,611
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$3,511,730
Employer contributions (assets) at end of year	2010-12-31	$322,941
Employer contributions (assets) at beginning of year	2010-12-31	$272,645
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$644,752
Contract administrator fees	2010-12-31	$42,870
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$30,193
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$45,671
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	LEVITZACKS CPAS
Accountancy firm EIN	2010-12-31	953159181

Form 5500 Responses for HELIX ELECTRIC HEALTH AND WELFARE PLAN

2022: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: HELIX ELECTRIC HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	162070
Policy instance	6
Insurance contract or identification number 162070 Number of Individuals Covered 2038 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $31,938 Total amount of fees paid to insurance company USD $1,116 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $319,382 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $31,938 Amount paid for insurance broker fees 1116 Insurance broker organization code? 3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number	448625
Policy instance	16
Insurance contract or identification number 448625 Number of Individuals Covered 427 Insurance policy start date 2021-08-01 Insurance policy end date 2022-08-01 Total amount of commissions paid to insurance broker USD $20,124 Total amount of fees paid to insurance company USD $1,918 Other welfare benefits provided HOSPITAL EE PAID Welfare Benefit Premiums Paid to Carrier USD $37,831 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,500 Insurance broker organization code? 3 Amount paid for insurance broker fees 1437
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	1
Insurance contract or identification number 902601 Number of Individuals Covered 749 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $229,586 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,586,417 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $184,089 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number
Policy instance	2
Number of Individuals Covered 2195 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $14,058 Total amount of fees paid to insurance company USD $29 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $115,548 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,190 Insurance broker organization code? 3 Amount paid for insurance broker fees 29 Additional information about fees paid to insurance broker MGFT
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	031062-001
Policy instance	3
Insurance contract or identification number 031062-001 Number of Individuals Covered 53 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $329,210 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	03106-003
Policy instance	4
Insurance contract or identification number 03106-003 Number of Individuals Covered 4 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $43,408 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	5
Insurance contract or identification number 10001486 Number of Individuals Covered 505 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $60,931 Total amount of fees paid to insurance company USD $14,145 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,069,078 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,497 Insurance broker organization code? 3 Amount paid for insurance broker fees 9631
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	209166
Policy instance	7
Insurance contract or identification number 209166 Number of Individuals Covered 534 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $3,178 Total amount of fees paid to insurance company USD $51 Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $31,782 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,178 Amount paid for insurance broker fees 51 Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	303489
Policy instance	8
Insurance contract or identification number 303489 Number of Individuals Covered 268 Insurance policy start date 2023-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $12,519 Total amount of fees paid to insurance company USD $177 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $125,194 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,519 Amount paid for insurance broker fees 177 Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	328646
Policy instance	9
Insurance contract or identification number 328646 Number of Individuals Covered 502 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $19,118 Total amount of fees paid to insurance company USD $277 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $191,183 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,118 Amount paid for insurance broker fees 277 Insurance broker organization code? 3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number	448624
Policy instance	15
Insurance contract or identification number 448624 Number of Individuals Covered 416 Insurance policy start date 2021-08-01 Insurance policy end date 2022-08-01 Total amount of commissions paid to insurance broker USD $6,231 Total amount of fees paid to insurance company USD $2,077 Other welfare benefits provided ATTAINED AGE CRITICAL ILLNESS Welfare Benefit Premiums Paid to Carrier USD $41,543 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,673 Amount paid for insurance broker fees 1558 Insurance broker organization code? 3
SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )
Policy contract number	G10258771001
Policy instance	14
Insurance contract or identification number G10258771001 Number of Individuals Covered 100 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $26,184 Total amount of fees paid to insurance company USD $5,237 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $495,508 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,184 Amount paid for insurance broker fees 5237 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	607049
Policy instance	13
Insurance contract or identification number 607049 Number of Individuals Covered 385 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $75,212 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,035,245 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $75,212 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	235294
Policy instance	12
Insurance contract or identification number 235294 Number of Individuals Covered 394 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $82,097 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,270,033 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $82,097 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number	30444
Policy instance	11
Insurance contract or identification number 30444 Number of Individuals Covered 223 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $99,635 Total amount of fees paid to insurance company USD $60,180 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,992,699 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $99,635 Amount paid for insurance broker fees 60180 Insurance broker organization code? 3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number	448623
Policy instance	10
Insurance contract or identification number 448623 Number of Individuals Covered 659 Insurance policy start date 2021-08-01 Insurance policy end date 2022-08-01 Total amount of commissions paid to insurance broker USD $28,826 Total amount of fees paid to insurance company USD $3,290 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $64,974 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,540 Amount paid for insurance broker fees 2459 Insurance broker organization code? 3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	031062-001
Policy instance	5
Insurance contract or identification number 031062-001 Number of Individuals Covered 120 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $616,582 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	03106-003
Policy instance	6
Insurance contract or identification number 03106-003 Number of Individuals Covered 12 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,687 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10284581001
Policy instance	4
Insurance contract or identification number 10284581001 Number of Individuals Covered 1474 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $89,589 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	3
Insurance contract or identification number 902601 Number of Individuals Covered 874 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $221,130 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,706,717 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $192,383 Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3341789
Policy instance	2
Insurance contract or identification number 3341789 Number of Individuals Covered 410 Insurance policy start date 2021-08-01 Insurance policy end date 2022-07-31 Total amount of commissions paid to insurance broker USD $-330 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $62,105 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $-330 Insurance broker organization code? 4
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10171871001
Policy instance	1
Insurance contract or identification number 10171871001 Number of Individuals Covered 809 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,738 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	7
Insurance contract or identification number 10001486 Number of Individuals Covered 507 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $53,142 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,778,527 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $53,142 Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	209166
Policy instance	11
Insurance contract or identification number 209166 Number of Individuals Covered 542 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $3,133 Total amount of fees paid to insurance company USD $428 Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $31,327 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,133 Amount paid for insurance broker fees 428 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605928
Policy instance	9
Insurance contract or identification number 605928 Number of Individuals Covered 426 Insurance policy start date 2022-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $48,760 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,756,835 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $48,760 Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	162070
Policy instance	10
Insurance contract or identification number 162070 Number of Individuals Covered 2049 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $34,102 Total amount of fees paid to insurance company USD $4,696 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $341,024 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,102 Amount paid for insurance broker fees 4696 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	303489
Policy instance	12
Insurance contract or identification number 303489 Number of Individuals Covered 271 Insurance policy start date 2022-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $10,606 Total amount of fees paid to insurance company USD $1,515 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $106,057 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,606 Amount paid for insurance broker fees 1515 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	328646
Policy instance	13
Insurance contract or identification number 328646 Number of Individuals Covered 480 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $15,237 Total amount of fees paid to insurance company USD $2,092 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $152,370 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,237 Amount paid for insurance broker fees 2092 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	233947
Policy instance	8
Insurance contract or identification number 233947 Number of Individuals Covered 441 Insurance policy start date 2020-08-01 Insurance policy end date 2021-07-31 Total amount of commissions paid to insurance broker USD $51,700 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,899,299 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $51,700 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10284581001
Policy instance	2
Insurance contract or identification number 10284581001 Number of Individuals Covered 0 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $12,849 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $76,654 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,849 Insurance broker organization code? 4
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3341789
Policy instance	3
Insurance contract or identification number 3341789 Number of Individuals Covered 563 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $3,787 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $75,927 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,787 Insurance broker organization code? 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	G1802
Policy instance	4
Insurance contract or identification number G1802 Number of Individuals Covered 670 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $24,020 Total amount of fees paid to insurance company USD $1,924 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $130,671 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,020 Amount paid for insurance broker fees 1924 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	G1802
Policy instance	5
Insurance contract or identification number G1802 Number of Individuals Covered 243 Insurance policy start date 2019-07-01 Insurance policy end date 2020-06-30 Total amount of commissions paid to insurance broker USD $13,498 Total amount of fees paid to insurance company USD $1,162 Other welfare benefits provided CRITICAL ILLNESS Welfare Benefit Premiums Paid to Carrier USD $64,527 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,498 Amount paid for insurance broker fees 1162 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	6
Insurance contract or identification number 902601 Number of Individuals Covered 1594 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $230,201 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,009,649 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $200,294 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10284581001
Policy instance	7
Insurance contract or identification number 10284581001 Number of Individuals Covered 1616 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,038 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 4
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10171871001
Policy instance	1
Insurance contract or identification number 10171871001 Number of Individuals Covered 893 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $36,662 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	94761
Policy instance	8
Insurance contract or identification number 94761 Number of Individuals Covered 362 Insurance policy start date 2019-08-01 Insurance policy end date 2020-07-31 Total amount of commissions paid to insurance broker USD $9,846 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided HOSPITAL INDEMNITY Welfare Benefit Premiums Paid to Carrier USD $49,231 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,846 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	15
Insurance contract or identification number 902601 Number of Individuals Covered 1451 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $186,162 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,205,242 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $186,044 Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	650761
Policy instance	14
Insurance contract or identification number 650761 Number of Individuals Covered 356 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $18,533 Total amount of fees paid to insurance company USD $4,633 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $200,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,533 Amount paid for insurance broker fees 4633 Additional information about fees paid to insurance broker ADDITIONAL COMPESATION Insurance broker organization code? 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	425225
Policy instance	4
Insurance contract or identification number 425225 Number of Individuals Covered 2398 Insurance policy start date 2018-08-01 Insurance policy end date 2019-08-01 Total amount of commissions paid to insurance broker USD $9,730 Total amount of fees paid to insurance company USD $1,216 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $106,089 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,730 Amount paid for insurance broker fees 1216 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 4
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98877201001
Policy instance	3
Insurance contract or identification number 98877201001 Number of Individuals Covered 765 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $111 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,834 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $111 Insurance broker organization code? 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	233947
Policy instance	2
Insurance contract or identification number 233947 Number of Individuals Covered 496 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $45,383 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,019,313 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $45,383 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	605928
Policy instance	1
Insurance contract or identification number 605928 Number of Individuals Covered 421 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $34,398 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,565,036 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,398 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number	26306
Policy instance	6
Insurance contract or identification number 26306 Number of Individuals Covered 254 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $27,650 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $998,041 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,650 Insurance broker organization code? 4
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10171871002
Policy instance	8
Insurance contract or identification number 10171871002 Number of Individuals Covered 1432 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $11,102 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $80,926 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,102 Insurance broker organization code? 4
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	9901256
Policy instance	9
Insurance contract or identification number 9901256 Number of Individuals Covered 82 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $802 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided LEGAL SERVICES Welfare Benefit Premiums Paid to Carrier USD $8,022 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $802 Insurance broker organization code? 4
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3341789
Policy instance	10
Insurance contract or identification number 3341789 Number of Individuals Covered 545 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $3,416 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $75,548 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,416 Insurance broker organization code? 4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	G1802
Policy instance	11
Insurance contract or identification number G1802 Number of Individuals Covered 616 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $39,630 Total amount of fees paid to insurance company USD $1,304 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $66,091 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,630 Amount paid for insurance broker fees 346 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	G1802
Policy instance	12
Insurance contract or identification number G1802 Number of Individuals Covered 251 Insurance policy start date 2018-07-01 Insurance policy end date 2019-06-30 Total amount of commissions paid to insurance broker USD $32,755 Total amount of fees paid to insurance company USD $891 Other welfare benefits provided CRITICAL ILLNESS Welfare Benefit Premiums Paid to Carrier USD $43,641 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,755 Amount paid for insurance broker fees 240 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 4
HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 )
Policy contract number	31062 1
Policy instance	13
Insurance contract or identification number 31062 1 Number of Individuals Covered 194 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $370,637 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	7
Insurance contract or identification number 10001486 Number of Individuals Covered 450 Insurance policy start date 2018-08-01 Insurance policy end date 2019-07-31 Total amount of commissions paid to insurance broker USD $48,173 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,749,910 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $43,153 Insurance broker organization code? 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	425226
Policy instance	5
Insurance contract or identification number 425226 Number of Individuals Covered 795 Insurance policy start date 2018-08-01 Insurance policy end date 2019-08-01 Total amount of commissions paid to insurance broker USD $21,352 Total amount of fees paid to insurance company USD $2,669 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $233,632 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,352 Amount paid for insurance broker fees 2669 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	1
Insurance contract or identification number 225149 Number of Individuals Covered 565 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $70,667 Total amount of fees paid to insurance company USD $3,192 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,303,175 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $70,667 Insurance broker organization code? 3 Amount paid for insurance broker fees 3192
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	2
Insurance contract or identification number 37502 Number of Individuals Covered 464 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $56,026 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,769,810 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,026 Insurance broker organization code? 3
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number	899588-000
Policy instance	3
Insurance contract or identification number 899588-000 Number of Individuals Covered 956 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $6,924 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,924 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	4
Insurance contract or identification number 902601 Number of Individuals Covered 1410 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $194,871 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,495,832 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $194,954 Insurance broker organization code? 3
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number	56392
Policy instance	5
Insurance contract or identification number 56392 Number of Individuals Covered 64 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $180,472 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98877201001
Policy instance	6
Insurance contract or identification number 98877201001 Number of Individuals Covered 0 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,368 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	425225
Policy instance	7
Insurance contract or identification number 425225 Number of Individuals Covered 2200 Insurance policy start date 2017-08-01 Insurance policy end date 2018-08-01 Total amount of commissions paid to insurance broker USD $12,455 Total amount of fees paid to insurance company USD $3,114 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $124,546 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,455 Amount paid for insurance broker fees 3114 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number	23865
Policy instance	9
Insurance contract or identification number 23865 Number of Individuals Covered 269 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $39,174 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $932,380 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,174 Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	425226
Policy instance	8
Insurance contract or identification number 425226 Number of Individuals Covered 172 Insurance policy start date 2017-08-01 Insurance policy end date 2018-08-01 Total amount of commissions paid to insurance broker USD $10,318 Total amount of fees paid to insurance company USD $2,580 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $103,178 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,318 Amount paid for insurance broker fees 2580 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	10
Insurance contract or identification number 10001486 Number of Individuals Covered 507 Insurance policy start date 2017-08-01 Insurance policy end date 2018-07-31 Total amount of commissions paid to insurance broker USD $59,543 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,940,939 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $59,543 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	1
Insurance contract or identification number 225149 Number of Individuals Covered 655 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $57,617 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,128,442 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $35,527 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	2
Insurance contract or identification number 37502 Number of Individuals Covered 590 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $49,739 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,889,507 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $31,139 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number	899588-000
Policy instance	3
Insurance contract or identification number 899588-000 Number of Individuals Covered 911 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $6,664 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $123,762 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,664 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1038589
Policy instance	8
Insurance contract or identification number 1038589 Number of Individuals Covered 2325 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $11,961 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $133,762 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,305 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number	23865
Policy instance	7
Insurance contract or identification number 23865 Number of Individuals Covered 269 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $36,173 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $698,313 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,634 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1038590
Policy instance	9
Insurance contract or identification number 1038590 Number of Individuals Covered 550 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $3,207 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $32,069 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,775 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98877201001
Policy instance	6
Insurance contract or identification number 98877201001 Number of Individuals Covered 3090 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $14,232 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $181,011 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,058 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number	56392
Policy instance	5
Insurance contract or identification number 56392 Number of Individuals Covered 20 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $815 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $126,113 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $815 Insurance broker organization code? 3 Insurance broker name JOHN DELEE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	902601
Policy instance	4
Insurance contract or identification number 902601 Number of Individuals Covered 2002 Insurance policy start date 2016-08-01 Insurance policy end date 2017-07-31 Total amount of commissions paid to insurance broker USD $230,483 Total amount of fees paid to insurance company USD $297,822 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,685,090 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $128,402 Amount paid for insurance broker fees 297822 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number	56392
Policy instance	6
Insurance contract or identification number 56392 Number of Individuals Covered 54 Insurance policy start date 2015-08-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,276 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $48,223 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,276 Insurance broker organization code? 3 Insurance broker name JOHN DELEE
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	5
Insurance contract or identification number 10001486 Number of Individuals Covered 472 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $34,412 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,711,819 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,412 Insurance broker organization code? 3 Insurance broker name KAERCHER INSURANCE AGENCY, INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0902601
Policy instance	4
Insurance contract or identification number 0902601 Number of Individuals Covered 691 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $130,887 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,377,480 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $130,887 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number	899588-000
Policy instance	3
Insurance contract or identification number 899588-000 Number of Individuals Covered 618 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $5,059 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $99,637 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,059 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	1
Insurance contract or identification number 225149 Number of Individuals Covered 562 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $44,552 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,402,520 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,552 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number
Policy instance	7
Insurance policy start date 2015-01-01 Insurance policy end date 2016-12-31 Total amount of commissions paid to insurance broker USD $14,753 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $135,445 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,753 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	2
Insurance contract or identification number 37502 Number of Individuals Covered 338 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $27,665 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $835,976 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,665 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	12
Insurance contract or identification number 10001486 Number of Individuals Covered 658 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,989,181 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker name KAERCHER INSURANCE AGENCY, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	635834
Policy instance	10
Insurance contract or identification number 635834 Number of Individuals Covered 261 Insurance policy start date 2014-06-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $8,881 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $173,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,881 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	1
Insurance contract or identification number 10001486 Number of Individuals Covered 624 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $59,495 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,018,712 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $59,495 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	2
Insurance contract or identification number 225149 Number of Individuals Covered 344 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $27,584 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $957,820 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,584 Amount paid for insurance broker fees 0 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	3
Insurance contract or identification number 37502 Number of Individuals Covered 272 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $23,703 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $815,526 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,703 Amount paid for insurance broker fees 0 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	09499
Policy instance	11
Insurance contract or identification number 09499 Number of Individuals Covered 17 Insurance policy start date 2014-01-01 Insurance policy end date 2015-03-31 Total amount of commissions paid to insurance broker USD $2,516 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $20,458 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,258 Insurance broker organization code? 3 Insurance broker name NORMAN SARKIN
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0200
Policy instance	7
Insurance contract or identification number G0200 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,391,100 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0008708066
Policy instance	6
Insurance contract or identification number 0008708066 Number of Individuals Covered 14 Insurance policy start date 2014-01-01 Insurance policy end date 2015-01-01 Total amount of commissions paid to insurance broker USD $423 Total amount of fees paid to insurance company USD $79 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,517 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $284 Amount paid for insurance broker fees 79 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number	899588-000
Policy instance	8
Insurance contract or identification number 899588-000 Number of Individuals Covered 396 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $3,077 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $61,577 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,077 Amount paid for insurance broker fees 0 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number	G0360
Policy instance	5
Insurance contract or identification number G0360 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $89,050 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,298,184 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $89,050 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	TDI600010
Policy instance	4
Insurance contract or identification number TDI600010 Insurance policy start date 2013-11-01 Insurance policy end date 2014-11-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $121 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,313 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 121 Additional information about fees paid to insurance broker OVERRIDE Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1038589
Policy instance	13
Insurance contract or identification number 1038589 Number of Individuals Covered 1409 Insurance policy start date 2014-11-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $5,987 Total amount of fees paid to insurance company USD $212 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $59,867 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,987 Amount paid for insurance broker fees 212 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	1038589
Policy instance	9
Insurance contract or identification number 1038589 Number of Individuals Covered 1402 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $7,757 Total amount of fees paid to insurance company USD $3,061 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $77,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,757 Amount paid for insurance broker fees 3061 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	1
Insurance contract or identification number 10001486 Number of Individuals Covered 580 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $42,934 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,498,728 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $42,934 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	2
Insurance contract or identification number 225149 Number of Individuals Covered 226 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $26,004 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $873,107 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,004 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	3
Insurance contract or identification number 37502 Number of Individuals Covered 213 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $25,593 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $851,814 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,593 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	TDI600010
Policy instance	4
Insurance contract or identification number TDI600010 Insurance policy start date 2012-11-01 Insurance policy end date 2013-11-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $145 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,013 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 145 Additional information about fees paid to insurance broker OVERRIDE Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number	G0360
Policy instance	6
Insurance contract or identification number G0360 Number of Individuals Covered 331 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $110,339 Total amount of fees paid to insurance company USD $9,317 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,579,456 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $110,339 Amount paid for insurance broker fees 9317 Additional information about fees paid to insurance broker INCENTIVES, EDUCATION, COMMUNICATION & TRAINING Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0200
Policy instance	8
Insurance contract or identification number G0200 Number of Individuals Covered 477 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,083,690 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	671688
Policy instance	9
Insurance contract or identification number 671688 Number of Individuals Covered 893 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $14,489 Total amount of fees paid to insurance company USD $48,986 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,489 Amount paid for insurance broker fees 48986 Additional information about fees paid to insurance broker VOLUME INCENTIVES AND ADMINISTRATIVE FEES Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0008708066
Policy instance	7
Insurance contract or identification number 0008708066 Number of Individuals Covered 16 Insurance policy start date 2013-01-01 Insurance policy end date 2014-01-01 Total amount of commissions paid to insurance broker USD $650 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,226 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $332 Insurance broker organization code? 3 Insurance broker name CUSTOM BENEFIT PROGRAMS INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	671688
Policy instance	10
Insurance contract or identification number 671688 Number of Individuals Covered 1076 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $14,454 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $167,666 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,454 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 66141 )
Policy contract number	AZ6322
Policy instance	11
Insurance contract or identification number AZ6322 Number of Individuals Covered 32 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $12,527 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $203,753 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,527 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	11337
Policy instance	5
Insurance contract or identification number 11337 Number of Individuals Covered 85 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $221,150 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number	899588-000
Policy instance	12
Insurance contract or identification number 899588-000 Number of Individuals Covered 526 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $2,954 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $58,729 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,954 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
MEDCO CONTAINMENT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 44611 )
Policy contract number	2440
Policy instance	13
Insurance contract or identification number 2440 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $2,774 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $206,349 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK 816697
Policy instance	2
Insurance contract or identification number OK 816697 Insurance policy start date 2011-11-01 Insurance policy end date 2012-11-01 Total amount of commissions paid to insurance broker USD $101 Total amount of fees paid to insurance company USD $15 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $677 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $101 Amount paid for insurance broker fees 15 Additional information about fees paid to insurance broker SALES & SERVICE Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH NET OF AZ (National Association of Insurance Commissioners NAIC id number: 66141 )
Policy contract number	AZ6322
Policy instance	14
Insurance contract or identification number AZ6322 Number of Individuals Covered 68 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $10,437 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $193,310 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,437 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0368
Policy instance	3
Insurance contract or identification number G0368 Number of Individuals Covered 495 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $4,759 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Other welfare benefits provided ORTHODONTIA Welfare Benefit Premiums Paid to Carrier USD $57,093 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,759 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	4
Insurance contract or identification number 225149 Number of Individuals Covered 243 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $19,878 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $681,399 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,878 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	5
Insurance contract or identification number 37502 Number of Individuals Covered 237 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $15,727 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $558,159 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,727 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	TDI600010
Policy instance	6
Insurance contract or identification number TDI600010 Insurance policy start date 2011-11-01 Insurance policy end date 2012-11-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $75 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,839 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 75 Additional information about fees paid to insurance broker SALES & SERVICE Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	11337
Policy instance	7
Insurance contract or identification number 11337 Number of Individuals Covered 102 Insurance policy start date 2011-07-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $141,470 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	0008708066
Policy instance	9
Insurance contract or identification number 0008708066 Number of Individuals Covered 20 Insurance policy start date 2012-01-01 Insurance policy end date 2013-01-01 Total amount of commissions paid to insurance broker USD $1,711 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,805 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,304 Insurance broker organization code? 3 Insurance broker name CUSTOM BENEFIT PROGRAMS, INC
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number	G0360
Policy instance	8
Insurance contract or identification number G0360 Number of Individuals Covered 280 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $95,908 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,448,978 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $95,908 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	671688
Policy instance	11
Insurance contract or identification number 671688 Number of Individuals Covered 929 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $8,389 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,389 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0200
Policy instance	10
Insurance contract or identification number G0200 Number of Individuals Covered 596 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,817,200 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )
Policy contract number	K101058
Policy instance	12
Insurance contract or identification number K101058 Number of Individuals Covered 1192 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $12,459 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $102,361 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,459 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	671688
Policy instance	13
Insurance contract or identification number 671688 Number of Individuals Covered 463 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $11,023 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $40,090 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,023 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	1
Insurance contract or identification number 10001486 Number of Individuals Covered 476 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $36,629 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,214,483 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,629 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	38777
Policy instance	12
Insurance contract or identification number 38777 Number of Individuals Covered 15 Insurance policy start date 2010-01-01 Insurance policy end date 2011-01-01 Total amount of commissions paid to insurance broker USD $520 Total amount of fees paid to insurance company USD $186 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life 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
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number	25828
Policy instance	8
Insurance contract or identification number 25828 Number of Individuals Covered 26 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $12,009 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $240,170 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	671688
Policy instance	14
Insurance contract or identification number 671688 Number of Individuals Covered 631 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $10,913 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK 816697
Policy instance	2
Insurance contract or identification number OK 816697 Insurance policy start date 2010-11-01 Insurance policy end date 2011-11-01 Total amount of commissions paid to insurance broker USD $110 Total amount of fees paid to insurance company USD $11 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $731 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	NP 7741
Policy instance	3
Insurance contract or identification number NP 7741 Number of Individuals Covered 211 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $4,680 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided ORTHODONTIA Welfare Benefit Premiums Paid to Carrier USD $46,709 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149
Policy instance	4
Insurance contract or identification number 225149 Number of Individuals Covered 193 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $21,428 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $667,147 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502
Policy instance	5
Insurance contract or identification number 37502 Number of Individuals Covered 130 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $8,307 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $264,832 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	TDI600010
Policy instance	6
Insurance contract or identification number TDI600010 Insurance policy start date 2010-11-01 Insurance policy end date 2011-11-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $35 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,785 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	11337
Policy instance	7
Insurance contract or identification number 11337 Number of Individuals Covered 33 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $73,358 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TAKECARE (National Association of Insurance Commissioners NAIC id number: 11093 )
Policy contract number	HELIXEL1
Policy instance	9
Insurance contract or identification number HELIXEL1 Number of Individuals Covered 10 Insurance policy start date 2010-12-01 Insurance policy end date 2011-11-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $51,399 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number	G0360
Policy instance	10
Insurance contract or identification number G0360 Number of Individuals Covered 249 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,199,705 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	092780
Policy instance	11
Insurance contract or identification number 092780 Number of Individuals Covered 856 Insurance policy start date 2010-01-01 Insurance policy end date 2011-01-01 Total amount of commissions paid to insurance broker USD $2,369 Total amount of fees paid to insurance company USD $705 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $50,685 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0200
Policy instance	13
Insurance contract or identification number G0200 Number of Individuals Covered 494 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $81,124 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $1,496,468 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	1
Insurance contract or identification number 10001486 Number of Individuals Covered 419 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $47,623 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,117,571 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	38777
Policy instance	15
Insurance contract or identification number 38777 Number of Individuals Covered 37 Insurance policy start date 2009-01-01 Insurance policy end date 2010-01-01 Total amount of commissions paid to insurance broker USD $999 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided VWB Welfare Benefit Premiums Paid to Carrier USD $19,963 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $799 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number	25828
Policy instance	10
Insurance contract or identification number 25828 Number of Individuals Covered 44 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $17,384 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $347,682 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,384 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK 816697
Policy instance	3
Insurance contract or identification number OK 816697 Insurance policy start date 2009-11-01 Insurance policy end date 2010-11-01 Total amount of commissions paid to insurance broker USD $110 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $731 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $110 Insurance broker organization code? 3 Insurance broker name DRIVER ALLIANT INSURANCE SERVICES
GOLDEN WEST HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	NP 7741
Policy instance	4
Insurance contract or identification number NP 7741 Number of Individuals Covered 228 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $5,145 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided ORTHODONTIA Welfare Benefit Premiums Paid to Carrier USD $51,437 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,145 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149-0001
Policy instance	5
Insurance contract or identification number 225149-0001 Number of Individuals Covered 244 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $17,486 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $601,114 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,486 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	225149-7001
Policy instance	6
Insurance contract or identification number 225149-7001 Number of Individuals Covered 6 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $427 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,811 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $427 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502-0001
Policy instance	7
Insurance contract or identification number 37502-0001 Number of Individuals Covered 97 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $6,797 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $238,272 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,797 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10001486
Policy instance	2
Insurance contract or identification number 10001486 Number of Individuals Covered 485 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $39,954 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $950,177 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,954 Insurance broker organization code? 3 Insurance broker name DRIVER ALLIANT INSURANCE SERVICES
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	11337
Policy instance	9
Insurance contract or identification number 11337 Number of Individuals Covered 26 Insurance policy start date 2009-07-01 Insurance policy end date 2010-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $47,131 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	TDI600010
Policy instance	8
Insurance contract or identification number TDI600010 Insurance policy start date 2009-11-01 Insurance policy end date 2010-11-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,758 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TAKECARE (National Association of Insurance Commissioners NAIC id number: 11093 )
Policy contract number	HELIXEL1
Policy instance	11
Insurance contract or identification number HELIXEL1 Number of Individuals Covered 24 Insurance policy start date 2009-12-01 Insurance policy end date 2010-11-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $104,875 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number	G0360
Policy instance	12
Insurance contract or identification number G0360 Number of Individuals Covered 567 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $62,075 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $870,460 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $62,075 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	092780
Policy instance	13
Insurance contract or identification number 092780 Number of Individuals Covered 867 Insurance policy start date 2009-01-01 Insurance policy end date 2010-01-01 Total amount of commissions paid to insurance broker USD $4,942 Total amount of fees paid to insurance company USD $566 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $75,474 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,942 Insurance broker organization code? 3 Amount paid for insurance broker fees 566 Insurance broker name ROBERT F. DRIVER CO INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	092781
Policy instance	14
Insurance contract or identification number 092781 Number of Individuals Covered 25 Insurance policy start date 2009-01-01 Insurance policy end date 2010-01-01 Total amount of commissions paid to insurance broker USD $1,016 Total amount of fees paid to insurance company USD $152 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LIFESTYLE LIFE Welfare Benefit Premiums Paid to Carrier USD $20,313 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,016 Insurance broker organization code? 3 Amount paid for insurance broker fees 152 Insurance broker name ROBERT F. DRIVER CO INC.
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	G0200
Policy instance	16
Insurance contract or identification number G0200 Number of Individuals Covered 567 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,421,559 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	37502-7001
Policy instance	1
Insurance contract or identification number 37502-7001 Number of Individuals Covered 6 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $613 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $22,320 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $613 Insurance broker organization code? 3 Insurance broker name ALLIANT INSURANCE SERVICES, INC.