401k Plan data: KARR TUTTLE CAMPBELL BENEFIT PLAN plan

KARR TUTTLE CAMPBELL BENEFIT PLAN 401k Plan overview

Plan Name	KARR TUTTLE CAMPBELL BENEFIT PLAN
Plan identification number	501

KARR TUTTLE CAMPBELL 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) Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

KARR TUTTLE CAMPBELL, P.S. has sponsored the creation of one or more 401k plans.

Company Name: KARR TUTTLE CAMPBELL, P.S.

Employer identification number (EIN): 911006438

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KARR TUTTLE CAMPBELL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JOSE VASQUEZ 2023-07-25 JOSE VASQUEZ 2023-07-25
501 2021-01-01 JOSE VASQUEZ 2022-09-26 JOSE VASQUEZ 2022-09-26
501 2020-01-01 JOSE VASQUEZ 2021-10-13 JOSE VASQUEZ 2021-10-13
501 2019-01-01 BRUCE E. LARSON 2020-10-14 BRUCE E. LARSON 2020-10-14
501 2018-01-01 BRUCE E. LARSON 2019-10-09 BRUCE E. LARSON 2019-10-09
501 2017-01-01 BRUCE E. LARSON 2018-09-26 BRUCE E. LARSON 2018-09-26
501 2016-01-01 BRUCE E. LARSON 2017-10-15 BRUCE E. LARSON 2017-10-15
501 2015-01-01 BRUCE E. LARSON 2016-10-10 BRUCE E. LARSON 2016-10-10
501 2014-01-01 BRUCE E. LARSON BRUCE E. LARSON 2015-07-31
501 2013-01-01 BRUCE E. LARSON BRUCE E. LARSON 2014-07-31
501 2012-01-01 BRUCE E. LARSON BRUCE E. LARSON 2013-07-24
501 2011-01-01 BRUCE E. LARSON
501 2010-01-01 BRUCE E. LARSON
501 2009-01-01 BRUCE E. LARSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	JOSE VASQUEZ	2023-07-25	JOSE VASQUEZ	2023-07-25
501	2021-01-01	JOSE VASQUEZ	2022-09-26	JOSE VASQUEZ	2022-09-26
501	2020-01-01	JOSE VASQUEZ	2021-10-13	JOSE VASQUEZ	2021-10-13
501	2019-01-01	BRUCE E. LARSON	2020-10-14	BRUCE E. LARSON	2020-10-14
501	2018-01-01	BRUCE E. LARSON	2019-10-09	BRUCE E. LARSON	2019-10-09
501	2017-01-01	BRUCE E. LARSON	2018-09-26	BRUCE E. LARSON	2018-09-26
501	2016-01-01	BRUCE E. LARSON	2017-10-15	BRUCE E. LARSON	2017-10-15
501	2015-01-01	BRUCE E. LARSON	2016-10-10	BRUCE E. LARSON	2016-10-10
501	2014-01-01	BRUCE E. LARSON		BRUCE E. LARSON	2015-07-31
501	2013-01-01	BRUCE E. LARSON		BRUCE E. LARSON	2014-07-31
501	2012-01-01	BRUCE E. LARSON		BRUCE E. LARSON	2013-07-24
501	2011-01-01	BRUCE E. LARSON
501	2010-01-01	BRUCE E. LARSON
501	2009-01-01	BRUCE E. LARSON

Plan Statistics for KARR TUTTLE CAMPBELL BENEFIT PLAN

401k plan membership statisitcs for KARR TUTTLE CAMPBELL BENEFIT PLAN

Measure Date Value
2014: KARR TUTTLE CAMPBELL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 76
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 72
Total of all active and inactive participants 2014-01-01 72
Total participants 2014-01-01 72
2013: KARR TUTTLE CAMPBELL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 77
Total of all active and inactive participants 2013-01-01 77
Total participants 2013-01-01 77
2012: KARR TUTTLE CAMPBELL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 91
Total of all active and inactive participants 2012-01-01 91
Total participants 2012-01-01 91
2011: KARR TUTTLE CAMPBELL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 96
Total of all active and inactive participants 2011-01-01 96
Total participants 2011-01-01 96
2010: KARR TUTTLE CAMPBELL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 94
Total of all active and inactive participants 2010-01-01 94
Total participants 2010-01-01 94
2009: KARR TUTTLE CAMPBELL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 140
Total of all active and inactive participants 2009-01-01 140
Total participants 2009-01-01 140

Measure	Date	Value
2014: KARR TUTTLE CAMPBELL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	72
Total of all active and inactive participants	2014-01-01	72
Total participants	2014-01-01	72
2013: KARR TUTTLE CAMPBELL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	77
Total of all active and inactive participants	2013-01-01	77
Total participants	2013-01-01	77
2012: KARR TUTTLE CAMPBELL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	91
Total of all active and inactive participants	2012-01-01	91
Total participants	2012-01-01	91
2011: KARR TUTTLE CAMPBELL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	96
Total of all active and inactive participants	2011-01-01	96
Total participants	2011-01-01	96
2010: KARR TUTTLE CAMPBELL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	94
Total of all active and inactive participants	2010-01-01	94
Total participants	2010-01-01	94
2009: KARR TUTTLE CAMPBELL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	140
Total of all active and inactive participants	2009-01-01	140
Total participants	2009-01-01	140

Form 5500 Responses for KARR TUTTLE CAMPBELL BENEFIT PLAN

2014: KARR TUTTLE CAMPBELL 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: KARR TUTTLE CAMPBELL 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: KARR TUTTLE CAMPBELL 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: KARR TUTTLE CAMPBELL 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: KARR TUTTLE CAMPBELL BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: KARR TUTTLE CAMPBELL 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 funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	80
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $18,646
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,646
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5688700

Policy instance

Insurance contract or identification number	5688700
Number of Individuals Covered	59
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $26,239
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $679,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,239
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

1477500

Policy instance

Insurance contract or identification number	1477500
Number of Individuals Covered	13
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,660
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $116,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,660
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5289

Policy instance

Insurance contract or identification number	5289
Number of Individuals Covered	79
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,850
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,850
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	80
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $8,598
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,598
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5499600

Policy instance

Insurance contract or identification number	5499600
Number of Individuals Covered	18
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,410
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $176,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,410
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5289

Policy instance

Insurance contract or identification number	5289
Number of Individuals Covered	84
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,836
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,836
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	84
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $21,066
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,066
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	84
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $9,556
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,556
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5688700

Policy instance

Insurance contract or identification number	5688700
Number of Individuals Covered	59
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $23,821
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $516,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,821
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5499600

Policy instance

Insurance contract or identification number	5499600
Number of Individuals Covered	18
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,707
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,707
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	91
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $7,482
Life 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 $7,482
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	90
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $18,511
Long Term Disability 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 $18,511
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5289

Policy instance

Insurance contract or identification number	5289
Number of Individuals Covered	86
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,221
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 $4,221
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5688700

Policy instance

Insurance contract or identification number	5688700
Number of Individuals Covered	57
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $18,322
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $461,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,322
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	91
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $20,667
Life Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5289

Policy instance

Insurance contract or identification number	5289
Number of Individuals Covered	96
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,851
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5499600

Policy instance

Insurance contract or identification number	5499600
Number of Individuals Covered	86
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $31,536
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $792,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	91
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $9,619
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

819333-41-000

Policy instance

Insurance contract or identification number	819333-41-000
Number of Individuals Covered	48
Insurance policy start date	2010-01-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $252
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $252
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5289

Policy instance

Insurance contract or identification number	5289
Number of Individuals Covered	94
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,253
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 $0
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	92
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,782
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,771
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6270700

Policy instance

Insurance contract or identification number	6270700
Number of Individuals Covered	84
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $27,262
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $742,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,262
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

819333-10-000

Policy instance

Insurance contract or identification number	819333-10-000
Number of Individuals Covered	94
Insurance policy start date	2010-01-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $1,066
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,066
Insurance broker organization code?	3
Insurance broker name	PACIFIC UNDERWRITERS CORP.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

445428

Policy instance

Insurance contract or identification number	445428
Number of Individuals Covered	91
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $17,862
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,862
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL BENEFIT CONSULTANTS

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Company Name:	KARR TUTTLE CAMPBELL, P.S.
Employer identification number (EIN):	911006438
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers