CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2021 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2021 401k financial data |
|---|
| Transfers to/from the plan | 2021-06-15 | $0 |
| Total income from all sources | 2021-06-15 | $1,235,104 |
| Expenses. Total of all expenses incurred | 2021-06-15 | $1,286,826 |
| Total plan assets at end of year | 2021-06-15 | $0 |
| Total plan assets at beginning of year | 2021-06-15 | $51,722 |
| Value of fidelity bond covering the plan | 2021-06-15 | $3,000,000 |
| Expenses. Other expenses not covered elsewhere | 2021-06-15 | $1,285,619 |
| Other income received | 2021-06-15 | $1,235,104 |
| Net income (gross income less expenses) | 2021-06-15 | $-51,722 |
| Net plan assets at end of year (total assets less liabilities) | 2021-06-15 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-06-15 | $51,722 |
| Total contributions received or receivable from employer(s) | 2021-06-15 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-06-15 | $1,207 |
| 2020 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2020 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2020-12-31 | $55,700 |
| Total income from all sources | 2020-12-31 | $1,919,834 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $2,387,198 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $0 |
| Total plan assets at end of year | 2020-12-31 | $51,722 |
| Total plan assets at beginning of year | 2020-12-31 | $574,786 |
| Value of fidelity bond covering the plan | 2020-12-31 | $3,000,000 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $2,284,368 |
| Other income received | 2020-12-31 | $1,860,347 |
| Noncash contributions received | 2020-12-31 | $55,700 |
| Net income (gross income less expenses) | 2020-12-31 | $-467,364 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $51,722 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $519,086 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $3,787 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $102,830 |
| 2019 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $55,700 |
| Total income from all sources (including contributions) | 2019-12-31 | $3,109,676 |
| Total of all expenses incurred | 2019-12-31 | $3,159,225 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $3,086,077 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $3,109,676 |
| Value of total assets at end of year | 2019-12-31 | $574,786 |
| Value of total assets at beginning of year | 2019-12-31 | $568,635 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $73,148 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2019-12-31 | $0 |
| Administrative expenses professional fees incurred | 2019-12-31 | $22,700 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $3,000,000 |
| 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 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $55,700 |
| Administrative expenses (other) incurred | 2019-12-31 | $8 |
| Total non interest bearing cash at end of year | 2019-12-31 | $574,786 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $568,635 |
| 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 | $-49,549 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $519,086 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $568,635 |
| 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 leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $43,274 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $3,086,077 |
| 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 |
| 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 | $3,109,676 |
| Contract administrator fees | 2019-12-31 | $7,166 |
| Did the plan have assets held for investment | 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Accountancy firm name | 2019-12-31 | ALEGRIA AND COMPANY P.S. |
| Accountancy firm EIN | 2019-12-31 | 910856953 |
| Total income from all sources (including contributions) | 2019-10-31 | $19,050,094 |
| Total of all expenses incurred | 2019-10-31 | $21,711,795 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-10-31 | $21,507,589 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-10-31 | $18,896,656 |
| Value of total assets at end of year | 2019-10-31 | $568,635 |
| Value of total assets at beginning of year | 2019-10-31 | $3,230,336 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-10-31 | $204,206 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-10-31 | $153,438 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-10-31 | $153,438 |
| Administrative expenses professional fees incurred | 2019-10-31 | $20,650 |
| Was this plan covered by a fidelity bond | 2019-10-31 | Yes |
| Value of fidelity bond cover | 2019-10-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-10-31 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-10-31 | $2,823,422 |
| Administrative expenses (other) incurred | 2019-10-31 | $12,543 |
| Total non interest bearing cash at end of year | 2019-10-31 | $568,635 |
| Total non interest bearing cash at beginning of year | 2019-10-31 | $134,774 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-10-31 | No |
| Value of net income/loss | 2019-10-31 | $-2,661,701 |
| Value of net assets at end of year (total assets less liabilities) | 2019-10-31 | $568,635 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-10-31 | $3,230,336 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-10-31 | No |
| Investment advisory and management fees | 2019-10-31 | $65,469 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-10-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-10-31 | $2,441,871 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2019-10-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2019-10-31 | $653,691 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-10-31 | $18,684,167 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-10-31 | No |
| Contributions received in cash from employer | 2019-10-31 | $18,896,656 |
| Contract administrator fees | 2019-10-31 | $105,544 |
| Did the plan have assets held for investment | 2019-10-31 | 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 | 2019-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-10-31 | Unqualified |
| Accountancy firm name | 2019-10-31 | ALEGRIA AND COMPANY P.S. |
| Accountancy firm EIN | 2019-10-31 | 910856953 |
| 2018 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-10-31 | $18,856,655 |
| Total of all expenses incurred | 2018-10-31 | $18,648,632 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-10-31 | $18,446,587 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-10-31 | $18,869,113 |
| Value of total assets at end of year | 2018-10-31 | $3,230,336 |
| Value of total assets at beginning of year | 2018-10-31 | $3,022,313 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-10-31 | $202,045 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-10-31 | $53,839 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-10-31 | $53,839 |
| Administrative expenses professional fees incurred | 2018-10-31 | $13,950 |
| Was this plan covered by a fidelity bond | 2018-10-31 | Yes |
| Value of fidelity bond cover | 2018-10-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-10-31 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-10-31 | $392,700 |
| Administrative expenses (other) incurred | 2018-10-31 | $123,184 |
| Total non interest bearing cash at end of year | 2018-10-31 | $134,774 |
| Total non interest bearing cash at beginning of year | 2018-10-31 | $150,852 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-10-31 | No |
| Value of net income/loss | 2018-10-31 | $208,023 |
| Value of net assets at end of year (total assets less liabilities) | 2018-10-31 | $3,230,336 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-10-31 | $3,022,313 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-10-31 | $2,441,871 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-10-31 | $2,833,822 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2018-10-31 | $653,691 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2018-10-31 | $37,639 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-10-31 | $18,053,887 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-10-31 | $-66,297 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-10-31 | No |
| Contributions received in cash from employer | 2018-10-31 | $18,869,113 |
| Contract administrator fees | 2018-10-31 | $64,911 |
| Did the plan have assets held for investment | 2018-10-31 | 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 | 2018-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-10-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-10-31 | Disclaimer |
| Accountancy firm name | 2018-10-31 | ALEGRIA AND COMPANY P.S. |
| Accountancy firm EIN | 2018-10-31 | 910856953 |
| 2017 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-10-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-10-31 | $60,360 |
| Total income from all sources (including contributions) | 2017-10-31 | $18,115,250 |
| Total loss/gain on sale of assets | 2017-10-31 | $0 |
| Total of all expenses incurred | 2017-10-31 | $17,823,460 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-10-31 | $17,626,908 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-10-31 | $17,721,933 |
| Value of total assets at end of year | 2017-10-31 | $3,022,313 |
| Value of total assets at beginning of year | 2017-10-31 | $2,790,883 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-10-31 | $196,552 |
| Total interest from all sources | 2017-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-10-31 | $52,167 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-10-31 | $52,167 |
| Administrative expenses professional fees incurred | 2017-10-31 | $12,600 |
| Was this plan covered by a fidelity bond | 2017-10-31 | Yes |
| Value of fidelity bond cover | 2017-10-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-10-31 | No |
| Assets. Other investments not covered elsewhere at end of year | 2017-10-31 | $37,639 |
| Assets. Other investments not covered elsewhere at beginning of year | 2017-10-31 | $120,154 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-10-31 | $110,080 |
| Administrative expenses (other) incurred | 2017-10-31 | $118,785 |
| Total non interest bearing cash at end of year | 2017-10-31 | $150,852 |
| Total non interest bearing cash at beginning of year | 2017-10-31 | $132,727 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-10-31 | No |
| Value of net income/loss | 2017-10-31 | $291,790 |
| Value of net assets at end of year (total assets less liabilities) | 2017-10-31 | $3,022,313 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-10-31 | $2,730,523 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-10-31 | $2,833,822 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-10-31 | $2,538,002 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-10-31 | $17,516,828 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-10-31 | $341,150 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-10-31 | No |
| Contributions received in cash from employer | 2017-10-31 | $17,721,933 |
| Contract administrator fees | 2017-10-31 | $65,167 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-10-31 | $60,360 |
| Did the plan have assets held for investment | 2017-10-31 | 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 | 2017-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-10-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-10-31 | Disclaimer |
| Accountancy firm name | 2017-10-31 | ALEGRIA AND COMPANY P.S |
| Accountancy firm EIN | 2017-10-31 | 910856953 |
| 2016 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-10-31 | $60,360 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-10-31 | $104,500 |
| Total income from all sources (including contributions) | 2016-10-31 | $17,525,662 |
| Total loss/gain on sale of assets | 2016-10-31 | $0 |
| Total of all expenses incurred | 2016-10-31 | $17,735,841 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-10-31 | $17,535,319 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-10-31 | $17,444,453 |
| Value of total assets at end of year | 2016-10-31 | $2,790,883 |
| Value of total assets at beginning of year | 2016-10-31 | $3,045,202 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-10-31 | $200,522 |
| Total interest from all sources | 2016-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-10-31 | $55,953 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-10-31 | $55,953 |
| Administrative expenses professional fees incurred | 2016-10-31 | $11,000 |
| Was this plan covered by a fidelity bond | 2016-10-31 | Yes |
| Value of fidelity bond cover | 2016-10-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-10-31 | No |
| Assets. Other investments not covered elsewhere at end of year | 2016-10-31 | $120,154 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-10-31 | $60,360 |
| Administrative expenses (other) incurred | 2016-10-31 | $124,935 |
| Total non interest bearing cash at end of year | 2016-10-31 | $132,727 |
| Total non interest bearing cash at beginning of year | 2016-10-31 | $52,626 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-10-31 | No |
| Value of net income/loss | 2016-10-31 | $-210,179 |
| Value of net assets at end of year (total assets less liabilities) | 2016-10-31 | $2,730,523 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-10-31 | $2,940,702 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-10-31 | $2,538,002 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-10-31 | $2,992,576 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-10-31 | $17,474,959 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-10-31 | $25,256 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-10-31 | No |
| Assets. Value of employer real property at beginning of year | 2016-10-31 | $0 |
| Contributions received in cash from employer | 2016-10-31 | $17,444,453 |
| Contract administrator fees | 2016-10-31 | $64,587 |
| Liabilities. Value of benefit claims payable at end of year | 2016-10-31 | $60,360 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-10-31 | $104,500 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-10-31 | $0 |
| Did the plan have assets held for investment | 2016-10-31 | 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 | 2016-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-10-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-10-31 | Disclaimer |
| Accountancy firm name | 2016-10-31 | ALEGRIA AND COMPANY P.S. |
| Accountancy firm EIN | 2016-10-31 | 910856953 |
| 2015 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-10-31 | $104,500 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-10-31 | $72,226 |
| Total income from all sources (including contributions) | 2015-10-31 | $17,112,678 |
| Total loss/gain on sale of assets | 2015-10-31 | $0 |
| Total of all expenses incurred | 2015-10-31 | $17,228,593 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-10-31 | $17,028,142 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-10-31 | $17,083,480 |
| Value of total assets at end of year | 2015-10-31 | $3,045,202 |
| Value of total assets at beginning of year | 2015-10-31 | $3,128,843 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-10-31 | $200,451 |
| Total interest from all sources | 2015-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-10-31 | $64,906 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-10-31 | $64,906 |
| Administrative expenses professional fees incurred | 2015-10-31 | $19,733 |
| Was this plan covered by a fidelity bond | 2015-10-31 | Yes |
| Value of fidelity bond cover | 2015-10-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-10-31 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-10-31 | $104,500 |
| Administrative expenses (other) incurred | 2015-10-31 | $122,288 |
| Total non interest bearing cash at end of year | 2015-10-31 | $52,626 |
| Total non interest bearing cash at beginning of year | 2015-10-31 | $139,868 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-10-31 | No |
| Value of net income/loss | 2015-10-31 | $-115,915 |
| Value of net assets at end of year (total assets less liabilities) | 2015-10-31 | $2,940,702 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-10-31 | $3,056,617 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-10-31 | $2,992,576 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-10-31 | $2,988,975 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-10-31 | $16,923,642 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-10-31 | $-35,708 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-10-31 | No |
| Assets. Value of employer real property at end of year | 2015-10-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2015-10-31 | $0 |
| Contributions received in cash from employer | 2015-10-31 | $17,083,480 |
| Contract administrator fees | 2015-10-31 | $58,430 |
| Liabilities. Value of benefit claims payable at end of year | 2015-10-31 | $104,500 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-10-31 | $72,226 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-10-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-10-31 | $0 |
| Did the plan have assets held for investment | 2015-10-31 | 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 | 2015-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-10-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-10-31 | Disclaimer |
| Accountancy firm name | 2015-10-31 | ALEGRIA & COMPANY P.S. |
| Accountancy firm EIN | 2015-10-31 | 910856953 |
| 2014 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $92,904 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $346,315 |
| Total income from all sources (including contributions) | 2014-10-31 | $16,561,815 |
| Total loss/gain on sale of assets | 2014-10-31 | $0 |
| Total of all expenses incurred | 2014-10-31 | $16,659,467 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-10-31 | $16,479,028 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-10-31 | $16,558,172 |
| Value of total assets at end of year | 2014-10-31 | $3,149,521 |
| Value of total assets at beginning of year | 2014-10-31 | $3,500,584 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-10-31 | $180,439 |
| Total interest from all sources | 2014-10-31 | $3,643 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-10-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-10-31 | No |
| Administrative expenses professional fees incurred | 2014-10-31 | $20,500 |
| Was this plan covered by a fidelity bond | 2014-10-31 | Yes |
| Value of fidelity bond cover | 2014-10-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-10-31 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-10-31 | $72,226 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-10-31 | $20,678 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-10-31 | $20,515 |
| Administrative expenses (other) incurred | 2014-10-31 | $159,939 |
| Total non interest bearing cash at end of year | 2014-10-31 | $139,868 |
| Total non interest bearing cash at beginning of year | 2014-10-31 | $731,066 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-10-31 | No |
| Value of net income/loss | 2014-10-31 | $-97,652 |
| Value of net assets at end of year (total assets less liabilities) | 2014-10-31 | $3,056,617 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-10-31 | $3,154,269 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-10-31 | No |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-10-31 | $750,000 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-10-31 | $750,000 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-10-31 | $3,643 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-10-31 | $16,406,802 |
| Asset value of US Government securities at end of year | 2014-10-31 | $2,988,975 |
| Asset value of US Government securities at beginning of year | 2014-10-31 | $1,998,840 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-10-31 | No |
| Contributions received in cash from employer | 2014-10-31 | $16,558,172 |
| 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 | 2014-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-10-31 | $72,226 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-10-31 | $325,800 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-10-31 | $20,678 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-10-31 | $20,678 |
| Did the plan have assets held for investment | 2014-10-31 | 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 | 2014-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-10-31 | Unqualified |
| Accountancy firm name | 2014-10-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2014-10-31 | 910189318 |
| 2013 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-10-31 | $346,315 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-10-31 | $250,380 |
| Total income from all sources (including contributions) | 2013-10-31 | $15,749,987 |
| Total of all expenses incurred | 2013-10-31 | $16,098,423 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-10-31 | $15,912,302 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-10-31 | $15,739,510 |
| Value of total assets at end of year | 2013-10-31 | $3,500,584 |
| Value of total assets at beginning of year | 2013-10-31 | $3,753,085 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-10-31 | $186,121 |
| Total interest from all sources | 2013-10-31 | $4,301 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-10-31 | No |
| Administrative expenses professional fees incurred | 2013-10-31 | $20,295 |
| Was this plan covered by a fidelity bond | 2013-10-31 | Yes |
| Value of fidelity bond cover | 2013-10-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-10-31 | No |
| Contributions received from participants | 2013-10-31 | $79,188 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-10-31 | $20,515 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-10-31 | $19,380 |
| Other income not declared elsewhere | 2013-10-31 | $6,176 |
| Administrative expenses (other) incurred | 2013-10-31 | $165,826 |
| Total non interest bearing cash at end of year | 2013-10-31 | $731,066 |
| Total non interest bearing cash at beginning of year | 2013-10-31 | $984,845 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-10-31 | No |
| Value of net income/loss | 2013-10-31 | $-348,436 |
| Value of net assets at end of year (total assets less liabilities) | 2013-10-31 | $3,154,269 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-10-31 | $3,502,705 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-10-31 | $750,000 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-10-31 | $4,301 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-10-31 | $15,912,302 |
| Asset value of US Government securities at end of year | 2013-10-31 | $1,998,840 |
| Asset value of US Government securities at beginning of year | 2013-10-31 | $2,747,894 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-10-31 | No |
| Contributions received in cash from employer | 2013-10-31 | $15,660,322 |
| 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 | 2013-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-10-31 | $325,800 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-10-31 | $231,000 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2013-10-31 | $20,678 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2013-10-31 | $20,346 |
| Did the plan have assets held for investment | 2013-10-31 | 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 | 2013-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-10-31 | Unqualified |
| Accountancy firm name | 2013-10-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2013-10-31 | 910189318 |
| 2012 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $250,380 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $289,061 |
| Total income from all sources (including contributions) | 2012-10-31 | $15,409,946 |
| Total of all expenses incurred | 2012-10-31 | $16,099,771 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-10-31 | $15,921,308 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-10-31 | $15,408,019 |
| Value of total assets at end of year | 2012-10-31 | $3,753,085 |
| Value of total assets at beginning of year | 2012-10-31 | $4,481,591 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-10-31 | $178,463 |
| Total interest from all sources | 2012-10-31 | $1,927 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-10-31 | No |
| Administrative expenses professional fees incurred | 2012-10-31 | $102,731 |
| Was this plan covered by a fidelity bond | 2012-10-31 | Yes |
| Value of fidelity bond cover | 2012-10-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-10-31 | No |
| Contributions received from participants | 2012-10-31 | $34,449 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-10-31 | $19,380 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-10-31 | $18,245 |
| Administrative expenses (other) incurred | 2012-10-31 | $75,732 |
| Total non interest bearing cash at end of year | 2012-10-31 | $984,845 |
| Total non interest bearing cash at beginning of year | 2012-10-31 | $3,861,389 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Value of net income/loss | 2012-10-31 | $-689,825 |
| Value of net assets at end of year (total assets less liabilities) | 2012-10-31 | $3,502,705 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-10-31 | $4,192,530 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-10-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-10-31 | $1,927 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-10-31 | $15,921,308 |
| Asset value of US Government securities at end of year | 2012-10-31 | $2,747,894 |
| Asset value of US Government securities at beginning of year | 2012-10-31 | $599,856 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-10-31 | No |
| Contributions received in cash from employer | 2012-10-31 | $15,373,570 |
| 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 | 2012-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-10-31 | $231,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-10-31 | $270,816 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-10-31 | $20,346 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-10-31 | $20,346 |
| Did the plan have assets held for investment | 2012-10-31 | 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 | 2012-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-10-31 | Unqualified |
| Accountancy firm name | 2012-10-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2012-10-31 | 910189318 |
| 2011 : CENTRAL WA SCHOOL EMPLOYEES BENEFIT PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $289,061 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $82,608 |
| Total income from all sources (including contributions) | 2011-10-31 | $15,622,103 |
| Total of all expenses incurred | 2011-10-31 | $15,913,344 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-10-31 | $15,746,662 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-10-31 | $15,616,983 |
| Value of total assets at end of year | 2011-10-31 | $4,481,591 |
| Value of total assets at beginning of year | 2011-10-31 | $4,566,379 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-10-31 | $166,682 |
| Total interest from all sources | 2011-10-31 | $5,120 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-10-31 | No |
| Administrative expenses professional fees incurred | 2011-10-31 | $91,805 |
| Was this plan covered by a fidelity bond | 2011-10-31 | Yes |
| Value of fidelity bond cover | 2011-10-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-10-31 | No |
| Contributions received from participants | 2011-10-31 | $54,199 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-10-31 | $594,817 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-10-31 | $18,245 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-10-31 | $17,048 |
| Administrative expenses (other) incurred | 2011-10-31 | $73,677 |
| Total non interest bearing cash at end of year | 2011-10-31 | $3,861,389 |
| Total non interest bearing cash at beginning of year | 2011-10-31 | $3,951,216 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Income. Non cash contributions | 2011-10-31 | $467,503 |
| Value of net income/loss | 2011-10-31 | $-291,241 |
| Value of net assets at end of year (total assets less liabilities) | 2011-10-31 | $4,192,530 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-10-31 | $4,483,771 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-10-31 | No |
| Investment advisory and management fees | 2011-10-31 | $1,200 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-10-31 | $5,120 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-10-31 | $15,746,662 |
| Asset value of US Government securities at end of year | 2011-10-31 | $599,856 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-10-31 | No |
| Contributions received in cash from employer | 2011-10-31 | $15,095,281 |
| 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 | 2011-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-10-31 | $270,816 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-10-31 | $65,560 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2011-10-31 | $20,346 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-10-31 | $20,346 |
| Did the plan have assets held for investment | 2011-10-31 | 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 | 2011-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-10-31 | Unqualified |
| Accountancy firm name | 2011-10-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2011-10-31 | 910189318 |
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 1 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2584 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,778,471 | | 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 | 553851 |
| Policy instance | 2 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,888 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $13,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,888 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1385 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $707 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $293,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $707 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 4 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,006 | | Total amount of fees paid to insurance company | USD $167 | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $7,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Amount paid for insurance broker fees | 119 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 553851 |
| Policy instance | 1 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $13,074 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $87,118 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,074 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 2 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $7,745 | | Total amount of fees paid to insurance company | USD $158 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,909 | | Amount paid for insurance broker fees | 54 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 4 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1370 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $13,359 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $1,773,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,359 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 3 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2574 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,882,071 | | 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 | 553851 |
| Policy instance | 1 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $12,633 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $84,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 2 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $7,148 | | Total amount of fees paid to insurance company | USD $298 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 3 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2634 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,920,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 4 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1390 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $8,675 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $1,612,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 1 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2696 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | 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 $15,367,392 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1376 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $12,125 | | Total amount of fees paid to insurance company | USD $3,724 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | 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 $368,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,125 | | Amount paid for insurance broker fees | 3724 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 553851 |
| Policy instance | 4 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $10,859 | | Total amount of fees paid to insurance company | USD $0 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LONG TERM CARE | | 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 $74,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,859 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 5 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $6,568 | | Total amount of fees paid to insurance company | USD $223 | | 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 | Yes | | 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 $49,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,971 | | Amount paid for insurance broker fees | 70 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LINDA CRAIG |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 101389 |
| Policy instance | 2 |
| Insurance contract or identification number | 101389 | | Number of Individuals Covered | 2667 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,475,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 5 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $5,328 | | Total amount of fees paid to insurance company | USD $164 | | 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 | Yes | | 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 $41,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,648 | | Amount paid for insurance broker fees | 44 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LINDA F. CRAIG |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 553851 |
| Policy instance | 4 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $8,575 | | Total amount of fees paid to insurance company | USD $0 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LONG TERM CARE | | 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 $57,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,575 | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE, INC. |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1355 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $7,356 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | 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 $360,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,356 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 101389 |
| Policy instance | 2 |
| Insurance contract or identification number | 101389 | | Number of Individuals Covered | 2682 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $12 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,473,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE, INC. |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 1 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2730 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | 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 $15,022,155 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1346 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $7,381 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | 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 $337,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,381 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 101389 |
| Policy instance | 2 |
| Insurance contract or identification number | 101389 | | Number of Individuals Covered | 2688 | | 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 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,427,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 5 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $7,019 | | Total amount of fees paid to insurance company | USD $227 | | 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 | Yes | | 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 $52,031 | | Commission paid to Insurance Broker | USD $1,931 | | Amount paid for insurance broker fees | 57 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LINDA F. CRAIG |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 553851 |
| Policy instance | 4 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $7,511 | | Total amount of fees paid to insurance company | USD $0 | | 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 | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LONG TERM CARE | | 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 $50,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,511 | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE, INC. |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 1 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2748 | | 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 $7,932 | | 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 | Yes | | 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 $14,569,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7932 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE, INC. |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 2 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $10,513 | | Total amount of fees paid to insurance company | USD $114 | | 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 $53,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,170 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 35 | | Additional information about fees paid to insurance broker | FEES AWARDS PRIZES BONUSES NON-MONETARY COMPENSATION | | Insurance broker name | |
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| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 5 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2774 | | 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 $52,360 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,819,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 52360 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE INC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101389 |
| Policy instance | 4 |
| Insurance contract or identification number | 0101389 | | Number of Individuals Covered | 2723 | | 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 $24 | | 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 $1,346,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE INC. |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1293 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $16,154 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D/DEPENDENT LIFE/VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $342,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,154 | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE INC |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 553851 |
| Policy instance | 1 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $7,720 | | 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 | GROUP LONG TERM CARE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,720 | | Insurance broker organization code? | 3 | | Insurance broker name | ARGUS INSURANCE INC |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 5 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2752 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $12,910 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,401,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101389 |
| Policy instance | 4 |
| Insurance contract or identification number | 0101389 | | Number of Individuals Covered | 2716 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,453,140 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1276 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $8,108 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D/DEPENDENT LIFE/VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $337,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 2 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $13,866 | | Total amount of fees paid to insurance company | USD $168 | | 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 $47,218 | | 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 | 553851 |
| Policy instance | 1 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $7,228 | | 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 | LONG TERM CARE | | 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 | 553851 |
| Policy instance | 1 |
| Insurance contract or identification number | 553851 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $6,747 | | 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 | LONG TERM CARE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0101389 |
| Policy instance | 4 |
| Insurance contract or identification number | 0101389 | | Number of Individuals Covered | 2759 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,457,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
| Policy contract number | 10005522 |
| Policy instance | 5 |
| Insurance contract or identification number | 10005522 | | Number of Individuals Covered | 2791 | | 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 $234 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,151,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | HM825 |
| Policy instance | 2 |
| Insurance contract or identification number | HM825 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,324 | | Total amount of fees paid to insurance company | USD $485 | | 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 $30,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | WA06967W |
| Policy instance | 3 |
| Insurance contract or identification number | WA06967W | | Number of Individuals Covered | 1378 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $8,264 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D/DEPENDENT LIFE/VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $339,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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