401k Plan data: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN plan

SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN
Plan identification number	502

SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover

401k Sponsoring company profile

SALT LAKE COMMUNITY ACTION PROGRAM, INC. has sponsored the creation of one or more 401k plans.

Company Name: SALT LAKE COMMUNITY ACTION PROGRAM, INC.

Employer identification number (EIN): 870269683

NAIC Classification: 624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-01-01 STACY WEIGHT 2022-05-23 STACY WEIGHT 2022-05-23
502 2020-01-01
502 2019-01-01
502 2019-01-01
502 2018-01-01
502 2018-01-01
502 2017-01-01 JENNA SEELEY
502 2016-01-01 ERIN TRENBEATH-MURRAY
502 2015-01-01 ERIN TRENBEATH-MURRAY
502 2014-01-01 ERIN TERNBEATH-MURRAY
502 2013-01-01 ERIN TRENBEATH-MURRAY ERIN TRENBEATH-MURRAY 2014-05-12
502 2012-01-01 JEAN BOYACK JEAN BOYACK 2013-07-29
502 2011-01-01 JEAN BOYACK JEAN BOYACK 2012-07-19
502 2009-01-01 JEAN BOYACK JEAN BOYACK 2010-06-15
502 2009-01-01 JEAN BOYACK JEAN BOYACK 2010-06-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-01-01	STACY WEIGHT	2022-05-23	STACY WEIGHT	2022-05-23
502	2020-01-01
502	2019-01-01
502	2019-01-01
502	2018-01-01
502	2018-01-01
502	2017-01-01	JENNA SEELEY
502	2016-01-01	ERIN TRENBEATH-MURRAY
502	2015-01-01	ERIN TRENBEATH-MURRAY
502	2014-01-01	ERIN TERNBEATH-MURRAY
502	2013-01-01	ERIN TRENBEATH-MURRAY		ERIN TRENBEATH-MURRAY	2014-05-12
502	2012-01-01	JEAN BOYACK		JEAN BOYACK	2013-07-29
502	2011-01-01	JEAN BOYACK		JEAN BOYACK	2012-07-19
502	2009-01-01	JEAN BOYACK		JEAN BOYACK	2010-06-15
502	2009-01-01	JEAN BOYACK		JEAN BOYACK	2010-06-15

Plan Statistics for SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN

401k plan membership statisitcs for SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN

Measure Date Value
2021: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 796
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 621
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 621
2020: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 459
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 796
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 796
2019: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 417
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 459
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 459
2018: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 495
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 417
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 417
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Number of participants with account balances 2018-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
Number of employers contributing to the scheme 2018-01-01 0
2017: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 544
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 495
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 495
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
Number of employers contributing to the scheme 2017-01-01 0
2016: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 565
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 544
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
2015: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 480
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 565
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 565
2014: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 479
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 480
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 480
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
2013: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 479
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 479
Total of all active and inactive participants 2013-01-01 479
2012: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,238
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,238
Total of all active and inactive participants 2012-01-01 1,238
2011: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 494
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 471
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 471
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
2009: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 317
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 410
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 410

Measure	Date	Value
2021: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	796
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	621
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	621
2020: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	459
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	796
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	796
2019: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	417
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	459
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	459
2018: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	495
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	417
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	417
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
Number of employers contributing to the scheme	2018-01-01	0
2017: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	544
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	495
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	495
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
Number of employers contributing to the scheme	2017-01-01	0
2016: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	565
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	544
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
2015: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	480
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	565
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	565
2014: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	479
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	480
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	480
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
2013: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	479
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	479
Total of all active and inactive participants	2013-01-01	479
2012: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,238
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,238
Total of all active and inactive participants	2012-01-01	1,238
2011: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	494
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	471
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	471
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
2009: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	317
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	410
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	410

Form 5500 Responses for SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN

2021: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT 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	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SALT LAKE COMMUNITY ACTION PROGRAM WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTHIEST YOU (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	HYSLCAP
Policy instance	6
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	69188
Policy instance	5
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	RVX003
Policy instance	4
(National Association of Insurance Commissioners NAIC id number: )
Policy contract number	UCAP003SN
Policy instance	2
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	AVX13
Policy instance	1
BLOMQUIST HALE CONSULTING INC (National Association of Insurance Commissioners NAIC id number: 10310 )
Policy contract number	UTAHCOMMACTION
Policy instance	7
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	877675G
Policy instance	3
(National Association of Insurance Commissioners NAIC id number: )
Policy contract number	UCAP003SN
Policy instance	7
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	877675G
Policy instance	5
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	AVX13
Policy instance	3
BLOMQUIST HALE CONSULTING INC (National Association of Insurance Commissioners NAIC id number: 10310 )
Policy contract number	UCA
Policy instance	2
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number	SLCAP
Policy instance	1
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	AVX13
Policy instance	4
HEALTHIEST YOU (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	HYSLCAP
Policy instance	6
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	AVX13
Policy instance	1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	877675G
Policy instance	3
(National Association of Insurance Commissioners NAIC id number: )
Policy contract number	UCAP003SN
Policy instance	2
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	877675G
Policy instance	4
DENTIST DIRECT, LLC (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	AVX13
Policy instance	3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 )
Policy contract number	023167HNO
Policy instance	2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0231671
Policy instance	1
APS HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 96407 )
Policy contract number	SLCAP
Policy instance	2
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6727480000
Policy instance	1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00473153
Policy instance	3
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	599845
Policy instance	4
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	599845
Policy instance	2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	473153
Policy instance	3
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6727480000
Policy instance	1
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	599845
Policy instance	3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	473153
Policy instance	2
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6888301
Policy instance	1
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number	599845
Policy instance	3
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6883
Policy instance	1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	473153
Policy instance	4
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6883
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10029480
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10021081
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10063161
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	4000010000397
Policy instance	6
ALTIUS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95407 )
Policy contract number	6883
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10029480
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10021081
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10063161
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	4000010000397
Policy instance	6

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Company Name:	SALT LAKE COMMUNITY ACTION PROGRAM, INC.
Employer identification number (EIN):	870269683
NAIC Classification:	624200