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WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 401k Plan overview

Plan NameWASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN
Plan identification number 501

WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover
  • 10 or more employer plan under Code section 419A(f)(6).

401k Sponsoring company profile

WASHINGTON STATE AUTO DEALERS INSURANCE TRUST has sponsored the creation of one or more 401k plans.

Company Name:WASHINGTON STATE AUTO DEALERS INSURANCE TRUST
Employer identification number (EIN):916056560
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01CONNOR RYAN CONNOR RYAN2018-10-12
5012016-01-01CONNOR RYAN CONNOR RYAN2017-10-13
5012015-01-01CONNOR RYAN CONNOR RYAN2016-08-30
5012014-01-01CONNOR RYAN CONNOR RYAN2015-10-14
5012013-01-01CONNOR RYAN CONNOR RYAN2014-10-14
5012012-01-01CONNOR RYAN CONNOR RYAN2013-10-14
5012011-01-01WENDY POPKE WENDY POPKE2012-10-12
5012010-01-01WENDY POPKE WENDY POPKE2011-10-12
5012009-01-01WENDY POPKE WENDY POPKE2010-10-12

Plan Statistics for WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN

401k plan membership statisitcs for WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN

Measure Date Value
2023: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01777
Total number of active participants reported on line 7a of the Form 55002023-01-01572
Total of all active and inactive participants2023-01-01572
Total participants2023-01-01572
2022: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01931
Total number of active participants reported on line 7a of the Form 55002022-01-01777
Total of all active and inactive participants2022-01-01777
Total participants2022-01-01777
2021: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,513
Total number of active participants reported on line 7a of the Form 55002021-01-01931
Total of all active and inactive participants2021-01-01931
Total participants2021-01-01931
2020: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,345
Total number of active participants reported on line 7a of the Form 55002020-01-011,513
Total of all active and inactive participants2020-01-011,513
Total participants2020-01-011,513
2019: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,426
Total number of active participants reported on line 7a of the Form 55002019-01-011,345
Total of all active and inactive participants2019-01-011,345
Total participants2019-01-011,345
2018: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,069
Total number of active participants reported on line 7a of the Form 55002018-01-012,131
Total of all active and inactive participants2018-01-012,131
Total participants2018-01-012,131
2017: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,308
Total number of active participants reported on line 7a of the Form 55002017-01-012,069
Total of all active and inactive participants2017-01-012,069
2016: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,198
Total number of active participants reported on line 7a of the Form 55002016-01-011,308
Total of all active and inactive participants2016-01-011,308
2015: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01941
Total number of active participants reported on line 7a of the Form 55002015-01-011,198
Total of all active and inactive participants2015-01-011,198
2014: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01692
Total number of active participants reported on line 7a of the Form 55002014-01-01941
Total of all active and inactive participants2014-01-01941
2013: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01759
Total number of active participants reported on line 7a of the Form 55002013-01-01692
Total of all active and inactive participants2013-01-01692
2012: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01824
Total number of active participants reported on line 7a of the Form 55002012-01-01759
Total of all active and inactive participants2012-01-01759
2011: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,160
Total number of active participants reported on line 7a of the Form 55002011-01-01812
Number of retired or separated participants receiving benefits2011-01-0112
Total of all active and inactive participants2011-01-01824
2010: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01900
Total number of active participants reported on line 7a of the Form 55002010-01-011,147
Number of retired or separated participants receiving benefits2010-01-0113
Total of all active and inactive participants2010-01-011,160
2009: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,650
Total number of active participants reported on line 7a of the Form 55002009-01-01880
Number of retired or separated participants receiving benefits2009-01-0120
Total of all active and inactive participants2009-01-01900

Financial Data on WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN

Measure Date Value
2023 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$152,920
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$356,201
Total income from all sources (including contributions)2023-12-31$4,360,065
Total loss/gain on sale of assets2023-12-31$6,111
Total of all expenses incurred2023-12-31$4,441,148
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$4,052,098
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$4,285,355
Value of total assets at end of year2023-12-31$716,401
Value of total assets at beginning of year2023-12-31$1,000,765
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$389,050
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$13,840
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$13,840
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$21,615
Participant contributions at end of year2023-12-31$717
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$1,686
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$1,836
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$152,438
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$231,986
Other income not declared elsewhere2023-12-31$54,759
Administrative expenses (other) incurred2023-12-31$286,400
Liabilities. Value of operating payables at end of year2023-12-31$189
Liabilities. Value of operating payables at beginning of year2023-12-31$67,344
Total non interest bearing cash at end of year2023-12-31$124,889
Total non interest bearing cash at beginning of year2023-12-31$378,205
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$-81,083
Value of net assets at end of year (total assets less liabilities)2023-12-31$563,481
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$644,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Investment advisory and management fees2023-12-31$6,178
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$575,168
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$501,458
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-12-31$10,316
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-12-31$63,620
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-12-31$63,620
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$4,052,098
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$4,263,740
Employer contributions (assets) at end of year2023-12-31$3,625
Employer contributions (assets) at beginning of year2023-12-31$55,646
Contract administrator fees2023-12-31$55,217
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31No
Liabilities. Value of benefit claims payable at end of year2023-12-31$293
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$56,871
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Aggregate proceeds on sale of assets2023-12-31$14,500
Aggregate carrying amount (costs) on sale of assets2023-12-31$8,389
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2023-12-31910614823
2022 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$356,201
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$247,688
Total income from all sources (including contributions)2022-12-31$6,729,518
Total loss/gain on sale of assets2022-12-31$6,991
Total of all expenses incurred2022-12-31$6,911,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$6,371,907
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$6,819,123
Value of total assets at end of year2022-12-31$1,000,765
Value of total assets at beginning of year2022-12-31$1,074,275
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$539,634
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$13,665
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$13,665
Administrative expenses professional fees incurred2022-12-31$455,554
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$21,724
Participant contributions at beginning of year2022-12-31$3,207
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$1,836
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$1,967
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$231,986
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$191,693
Administrative expenses (other) incurred2022-12-31$8,531
Liabilities. Value of operating payables at end of year2022-12-31$67,344
Liabilities. Value of operating payables at beginning of year2022-12-31$23,884
Total non interest bearing cash at end of year2022-12-31$378,205
Total non interest bearing cash at beginning of year2022-12-31$349,730
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-182,023
Value of net assets at end of year (total assets less liabilities)2022-12-31$644,564
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$826,587
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$6,257
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$501,458
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$591,063
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$63,620
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$117,917
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$117,917
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$6,371,907
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-110,261
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$6,797,399
Employer contributions (assets) at end of year2022-12-31$55,646
Employer contributions (assets) at beginning of year2022-12-31$10,391
Contract administrator fees2022-12-31$69,292
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$56,871
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$32,111
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$13,000
Aggregate carrying amount (costs) on sale of assets2022-12-31$6,009
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2022-12-31910614823
2021 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$247,688
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$184,194
Total income from all sources (including contributions)2021-12-31$7,639,786
Total loss/gain on sale of assets2021-12-31$9,487
Total of all expenses incurred2021-12-31$7,644,190
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$7,077,017
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$7,585,749
Value of total assets at end of year2021-12-31$1,074,275
Value of total assets at beginning of year2021-12-31$1,015,185
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$567,173
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$15,867
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$15,867
Administrative expenses professional fees incurred2021-12-31$471,250
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$88,012
Participant contributions at end of year2021-12-31$3,207
Participant contributions at beginning of year2021-12-31$9,267
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$1,967
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$1,517
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$191,693
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$166,223
Administrative expenses (other) incurred2021-12-31$8,714
Liabilities. Value of operating payables at end of year2021-12-31$23,884
Liabilities. Value of operating payables at beginning of year2021-12-31$4,948
Total non interest bearing cash at end of year2021-12-31$349,730
Total non interest bearing cash at beginning of year2021-12-31$320,622
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-4,404
Value of net assets at end of year (total assets less liabilities)2021-12-31$826,587
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$830,991
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$6,566
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$591,063
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$538,726
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$117,917
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$140,634
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$140,634
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$28,683
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$7,497,737
Employer contributions (assets) at end of year2021-12-31$10,391
Employer contributions (assets) at beginning of year2021-12-31$4,419
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$7,077,017
Contract administrator fees2021-12-31$80,643
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$32,111
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$13,023
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$30,200
Aggregate carrying amount (costs) on sale of assets2021-12-31$20,713
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31SCHOEDEL & SCHOEDEL CPAS PLLC
Accountancy firm EIN2021-12-31910614823
2020 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$184,194
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$258,446
Total income from all sources (including contributions)2020-12-31$8,526,361
Total loss/gain on sale of assets2020-12-31$5,839
Total of all expenses incurred2020-12-31$8,447,485
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$7,815,890
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$8,466,425
Value of total assets at end of year2020-12-31$1,015,185
Value of total assets at beginning of year2020-12-31$1,010,561
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$631,595
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$13,140
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$13,140
Administrative expenses professional fees incurred2020-12-31$522,711
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$114,442
Participant contributions at end of year2020-12-31$9,267
Participant contributions at beginning of year2020-12-31$8,517
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$1,517
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$1,650
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$166,223
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$236,735
Other income not declared elsewhere2020-12-31$40,957
Administrative expenses (other) incurred2020-12-31$7,043
Liabilities. Value of operating payables at end of year2020-12-31$4,948
Liabilities. Value of operating payables at beginning of year2020-12-31$4,212
Total non interest bearing cash at end of year2020-12-31$320,622
Total non interest bearing cash at beginning of year2020-12-31$510,676
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$78,876
Value of net assets at end of year (total assets less liabilities)2020-12-31$830,991
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$752,115
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$5,522
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$538,726
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$478,790
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$140,634
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$6,641
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$6,641
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$7,815,890
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$8,351,983
Employer contributions (assets) at end of year2020-12-31$4,419
Employer contributions (assets) at beginning of year2020-12-31$4,287
Contract administrator fees2020-12-31$96,319
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$13,023
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$17,499
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$16,000
Aggregate carrying amount (costs) on sale of assets2020-12-31$10,161
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31SCHOEDEL & SCHOEDEL CPAS PLLC
Accountancy firm EIN2020-12-31910614823
2019 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$258,446
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$258,446
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$414,813
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$414,813
Total income from all sources (including contributions)2019-12-31$9,151,118
Total income from all sources (including contributions)2019-12-31$9,151,118
Total loss/gain on sale of assets2019-12-31$2,723
Total of all expenses incurred2019-12-31$9,148,056
Total of all expenses incurred2019-12-31$9,148,056
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$8,464,026
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$8,464,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$9,071,929
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$9,071,929
Value of total assets at end of year2019-12-31$1,010,561
Value of total assets at beginning of year2019-12-31$1,163,866
Value of total assets at beginning of year2019-12-31$1,163,866
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$684,030
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$684,030
Total interest from all sources2019-12-31$1
Total interest from all sources2019-12-31$1
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$14,001
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$14,001
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$14,001
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$14,001
Administrative expenses professional fees incurred2019-12-31$561,611
Administrative expenses professional fees incurred2019-12-31$561,611
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$120,708
Participant contributions at end of year2019-12-31$8,517
Participant contributions at end of year2019-12-31$8,517
Participant contributions at beginning of year2019-12-31$7,161
Participant contributions at beginning of year2019-12-31$7,161
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$1,650
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$1,650
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$1,809
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$1,809
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$236,735
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$236,735
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$180,618
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$180,618
Administrative expenses (other) incurred2019-12-31$6,393
Administrative expenses (other) incurred2019-12-31$6,393
Liabilities. Value of operating payables at end of year2019-12-31$4,212
Liabilities. Value of operating payables at end of year2019-12-31$4,212
Liabilities. Value of operating payables at beginning of year2019-12-31$34,257
Liabilities. Value of operating payables at beginning of year2019-12-31$34,257
Total non interest bearing cash at end of year2019-12-31$510,676
Total non interest bearing cash at end of year2019-12-31$510,676
Total non interest bearing cash at beginning of year2019-12-31$740,367
Total non interest bearing cash at beginning of year2019-12-31$740,367
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,062
Value of net income/loss2019-12-31$3,062
Value of net assets at end of year (total assets less liabilities)2019-12-31$752,115
Value of net assets at end of year (total assets less liabilities)2019-12-31$752,115
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$749,053
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$749,053
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$5,451
Investment advisory and management fees2019-12-31$5,451
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$478,790
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$478,790
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$400,051
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$400,051
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$6,641
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$6,641
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$287
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$287
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$287
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$287
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$1
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$1
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$8,464,026
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$8,464,026
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$62,464
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$62,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$8,951,221
Contributions received in cash from employer2019-12-31$8,951,221
Employer contributions (assets) at end of year2019-12-31$4,287
Employer contributions (assets) at end of year2019-12-31$4,287
Employer contributions (assets) at beginning of year2019-12-31$14,191
Employer contributions (assets) at beginning of year2019-12-31$14,191
Contract administrator fees2019-12-31$110,575
Contract administrator fees2019-12-31$110,575
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$17,499
Liabilities. Value of benefit claims payable at end of year2019-12-31$17,499
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$199,938
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$199,938
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$128,070
Aggregate proceeds on sale of assets2019-12-31$128,070
Aggregate carrying amount (costs) on sale of assets2019-12-31$125,347
Aggregate carrying amount (costs) on sale of assets2019-12-31$125,347
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm name2019-12-31SCHOEDEL & SCHOEDEL, CPAS PLLC
Accountancy firm EIN2019-12-31910614823
Accountancy firm EIN2019-12-31910614823
2018 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$414,813
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$326,241
Total income from all sources (including contributions)2018-12-31$8,850,885
Total loss/gain on sale of assets2018-12-31$3,191
Total of all expenses incurred2018-12-31$8,562,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$7,875,820
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$8,874,167
Value of total assets at end of year2018-12-31$1,163,866
Value of total assets at beginning of year2018-12-31$786,998
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$686,769
Total interest from all sources2018-12-31$4
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$12,361
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$12,361
Administrative expenses professional fees incurred2018-12-31$547,924
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$92,747
Participant contributions at end of year2018-12-31$7,161
Participant contributions at beginning of year2018-12-31$505
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$1,809
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$1,431
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$180,618
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$157,837
Administrative expenses (other) incurred2018-12-31$9,110
Liabilities. Value of operating payables at end of year2018-12-31$34,257
Liabilities. Value of operating payables at beginning of year2018-12-31$24,948
Total non interest bearing cash at end of year2018-12-31$740,367
Total non interest bearing cash at beginning of year2018-12-31$290,865
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$288,296
Value of net assets at end of year (total assets less liabilities)2018-12-31$749,053
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$460,757
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$5,140
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$400,051
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$423,337
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$287
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$6
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$6
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$4
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$7,875,820
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-38,838
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$8,781,420
Employer contributions (assets) at end of year2018-12-31$14,191
Employer contributions (assets) at beginning of year2018-12-31$70,854
Contract administrator fees2018-12-31$124,595
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$199,938
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$143,456
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$13,000
Aggregate carrying amount (costs) on sale of assets2018-12-31$9,809
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31SCHOEDEL & SCHOEDEL CPAS, PLLC
Accountancy firm EIN2018-12-31910614823
2017 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$326,241
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$267,750
Total income from all sources (including contributions)2017-12-31$8,947,863
Total loss/gain on sale of assets2017-12-31$4,549
Total of all expenses incurred2017-12-31$9,125,089
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$8,431,209
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$8,883,464
Value of total assets at end of year2017-12-31$786,998
Value of total assets at beginning of year2017-12-31$905,733
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$693,880
Total interest from all sources2017-12-31$6
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$9,001
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$9,001
Administrative expenses professional fees incurred2017-12-31$546,491
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$53,517
Participant contributions at end of year2017-12-31$505
Participant contributions at beginning of year2017-12-31$4,245
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$1,431
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$13,280
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$157,837
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$221,039
Administrative expenses (other) incurred2017-12-31$9,259
Liabilities. Value of operating payables at end of year2017-12-31$24,948
Liabilities. Value of operating payables at beginning of year2017-12-31$9,825
Total non interest bearing cash at end of year2017-12-31$290,865
Total non interest bearing cash at beginning of year2017-12-31$310,900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-177,226
Value of net assets at end of year (total assets less liabilities)2017-12-31$460,757
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$637,983
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$5,351
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$423,337
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$565,481
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$6
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$33
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$33
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$6
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$8,431,209
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$50,843
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$8,829,947
Employer contributions (assets) at end of year2017-12-31$70,854
Employer contributions (assets) at beginning of year2017-12-31$11,794
Contract administrator fees2017-12-31$132,779
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$143,456
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$36,886
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$405,637
Aggregate carrying amount (costs) on sale of assets2017-12-31$401,088
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31SCHOEDEL & SCHOEDEL CPAS, PLLC
Accountancy firm EIN2017-12-31910614823
2016 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$267,750
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$349,472
Total income from all sources (including contributions)2016-12-31$9,494,085
Total loss/gain on sale of assets2016-12-31$-15,191
Total of all expenses incurred2016-12-31$10,241,640
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$9,382,816
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$9,406,375
Value of total assets at end of year2016-12-31$905,733
Value of total assets at beginning of year2016-12-31$1,735,010
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$858,824
Total interest from all sources2016-12-31$5
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$27,934
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$27,934
Administrative expenses professional fees incurred2016-12-31$702,981
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$66,530
Participant contributions at end of year2016-12-31$4,245
Participant contributions at beginning of year2016-12-31$43
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$13,280
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$1,872
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$221,039
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$194,967
Administrative expenses (other) incurred2016-12-31$9,131
Liabilities. Value of operating payables at end of year2016-12-31$9,825
Liabilities. Value of operating payables at beginning of year2016-12-31$23,825
Total non interest bearing cash at end of year2016-12-31$310,900
Total non interest bearing cash at beginning of year2016-12-31$384,911
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-747,555
Value of net assets at end of year (total assets less liabilities)2016-12-31$637,983
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,385,538
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$9,356
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$565,481
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$1,328,302
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$33
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$3
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$3
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$5
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$9,382,816
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$74,962
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$9,339,845
Employer contributions (assets) at end of year2016-12-31$11,794
Employer contributions (assets) at beginning of year2016-12-31$19,879
Contract administrator fees2016-12-31$137,356
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$36,886
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$130,680
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$983,452
Aggregate carrying amount (costs) on sale of assets2016-12-31$998,643
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31SCHOEDEL & SCHOEDEL CPAS, PLLC
Accountancy firm EIN2016-12-31910614823
2015 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$349,472
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$170,325
Total income from all sources (including contributions)2015-12-31$7,138,360
Total loss/gain on sale of assets2015-12-31$11,234
Total of all expenses incurred2015-12-31$7,964,662
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$7,271,733
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$7,150,067
Value of total assets at end of year2015-12-31$1,735,010
Value of total assets at beginning of year2015-12-31$2,382,165
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$692,929
Total interest from all sources2015-12-31$16
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$44,159
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$44,159
Administrative expenses professional fees incurred2015-12-31$537,275
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$78,130
Participant contributions at end of year2015-12-31$43
Participant contributions at beginning of year2015-12-31$2,866
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$1,872
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$3,523
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$194,967
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$41,667
Administrative expenses (other) incurred2015-12-31$12,169
Liabilities. Value of operating payables at end of year2015-12-31$23,825
Liabilities. Value of operating payables at beginning of year2015-12-31$33,641
Total non interest bearing cash at end of year2015-12-31$384,911
Total non interest bearing cash at beginning of year2015-12-31$335,440
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-826,302
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,385,538
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$2,211,840
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$13,668
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$1,328,302
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,040,321
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$3
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$15
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$15
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$16
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$7,271,733
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-67,116
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$7,071,937
Employer contributions (assets) at end of year2015-12-31$19,879
Contract administrator fees2015-12-31$129,817
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Liabilities. Value of benefit claims payable at end of year2015-12-31$130,680
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$95,017
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$2,815,618
Aggregate carrying amount (costs) on sale of assets2015-12-31$2,804,384
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2015-12-31910614823
2014 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$170,325
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$318,714
Total income from all sources (including contributions)2014-12-31$5,298,703
Total loss/gain on sale of assets2014-12-31$349,026
Total of all expenses incurred2014-12-31$6,046,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$5,560,397
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$5,181,576
Value of total assets at end of year2014-12-31$2,382,165
Value of total assets at beginning of year2014-12-31$3,278,357
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$486,109
Total interest from all sources2014-12-31$8
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$71,868
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$71,868
Administrative expenses professional fees incurred2014-12-31$364,237
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$85,368
Participant contributions at end of year2014-12-31$2,866
Participant contributions at beginning of year2014-12-31$1,682
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$3,523
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$1,650
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$41,667
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$126,792
Administrative expenses (other) incurred2014-12-31$8,726
Liabilities. Value of operating payables at end of year2014-12-31$33,641
Liabilities. Value of operating payables at beginning of year2014-12-31$30,311
Total non interest bearing cash at end of year2014-12-31$335,440
Total non interest bearing cash at beginning of year2014-12-31$271,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-747,803
Value of net assets at end of year (total assets less liabilities)2014-12-31$2,211,840
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$2,959,643
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$27,476
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$2,040,321
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$2,982,783
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$15
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$1,907
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$1,907
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$8
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$5,560,397
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-303,775
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$5,096,208
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$18,687
Contract administrator fees2014-12-31$85,670
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Liabilities. Value of benefit claims payable at end of year2014-12-31$95,017
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$161,611
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$3,195,394
Aggregate carrying amount (costs) on sale of assets2014-12-31$2,846,368
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2014-12-31910614823
2013 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$318,714
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$238,552
Total income from all sources (including contributions)2013-12-31$4,198,739
Total loss/gain on sale of assets2013-12-31$20,097
Total of all expenses incurred2013-12-31$4,090,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,704,111
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$3,927,411
Value of total assets at end of year2013-12-31$3,278,357
Value of total assets at beginning of year2013-12-31$3,089,562
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$385,995
Total interest from all sources2013-12-31$35
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$68,997
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$68,997
Administrative expenses professional fees incurred2013-12-31$286,213
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$63,171
Participant contributions at end of year2013-12-31$1,682
Participant contributions at beginning of year2013-12-31$724
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$1,650
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$2,268
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$126,792
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$139,055
Administrative expenses (other) incurred2013-12-31$9,108
Liabilities. Value of operating payables at end of year2013-12-31$30,311
Liabilities. Value of operating payables at beginning of year2013-12-31$19,569
Total non interest bearing cash at end of year2013-12-31$271,648
Total non interest bearing cash at beginning of year2013-12-31$264,581
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$108,633
Value of net assets at end of year (total assets less liabilities)2013-12-31$2,959,643
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$2,851,010
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$30,530
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$2,982,783
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$2,821,989
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$1,907
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$35
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$3,704,111
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$182,199
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$3,864,240
Employer contributions (assets) at end of year2013-12-31$18,687
Contract administrator fees2013-12-31$60,144
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$161,611
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$79,928
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$894,788
Aggregate carrying amount (costs) on sale of assets2013-12-31$874,691
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2013-12-31910614823
2012 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$238,552
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$345,781
Total income from all sources (including contributions)2012-12-31$4,694,240
Total loss/gain on sale of assets2012-12-31$31,691
Total of all expenses incurred2012-12-31$4,586,072
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$4,132,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$4,415,860
Value of total assets at end of year2012-12-31$3,089,562
Value of total assets at beginning of year2012-12-31$3,088,623
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$453,112
Total interest from all sources2012-12-31$82
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$78,351
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$78,351
Administrative expenses professional fees incurred2012-12-31$325,735
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$97,835
Participant contributions at end of year2012-12-31$724
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$2,268
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$5,444
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$139,055
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$126,790
Other income not declared elsewhere2012-12-31$15,162
Administrative expenses (other) incurred2012-12-31$11,420
Liabilities. Value of operating payables at end of year2012-12-31$19,569
Liabilities. Value of operating payables at beginning of year2012-12-31$12,332
Total non interest bearing cash at end of year2012-12-31$264,581
Total non interest bearing cash at beginning of year2012-12-31$414,684
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$108,168
Value of net assets at end of year (total assets less liabilities)2012-12-31$2,851,010
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,742,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$28,791
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,821,989
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$2,668,495
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$82
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$4,132,960
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$153,094
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$4,318,025
Contract administrator fees2012-12-31$87,166
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$79,928
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$206,659
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$1,723,943
Aggregate carrying amount (costs) on sale of assets2012-12-31$1,692,252
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2012-12-31910614823
2011 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$345,781
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$483,611
Total income from all sources (including contributions)2011-12-31$3,739,834
Total loss/gain on sale of assets2011-12-31$-21,008
Total of all expenses incurred2011-12-31$4,109,437
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,718,986
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$3,714,309
Value of total assets at end of year2011-12-31$3,088,623
Value of total assets at beginning of year2011-12-31$3,596,056
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$390,451
Total interest from all sources2011-12-31$1,231
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$46,776
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$46,776
Administrative expenses professional fees incurred2011-12-31$264,901
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$72,085
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$388
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$5,444
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$36,037
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$126,790
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$305,777
Other income not declared elsewhere2011-12-31$43,122
Administrative expenses (other) incurred2011-12-31$30,944
Liabilities. Value of operating payables at end of year2011-12-31$12,332
Liabilities. Value of operating payables at beginning of year2011-12-31$15,158
Total non interest bearing cash at end of year2011-12-31$414,684
Total non interest bearing cash at beginning of year2011-12-31$287,078
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-369,603
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,742,842
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,112,445
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$8,165
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$2,668,495
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$3,250,471
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$3,250,471
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$1,231
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$3,695,495
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-44,596
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$3,642,224
Employer contributions (assets) at end of year2011-12-31$0
Employer contributions (assets) at beginning of year2011-12-31$22,082
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$23,491
Contract administrator fees2011-12-31$86,441
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$206,659
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$162,676
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$1,523,832
Aggregate carrying amount (costs) on sale of assets2011-12-31$1,544,840
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2011-12-31910614823
2010 : WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$483,611
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$123,383
Total income from all sources (including contributions)2010-12-31$1,938,189
Total of all expenses incurred2010-12-31$2,178,628
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,772,346
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,899,951
Value of total assets at end of year2010-12-31$3,596,056
Value of total assets at beginning of year2010-12-31$3,476,267
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$406,282
Total interest from all sources2010-12-31$13,126
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$248,376
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$83,466
Participant contributions at end of year2010-12-31$388
Participant contributions at beginning of year2010-12-31$3,344
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$36,037
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$9,469
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$305,777
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$102,150
Other income not declared elsewhere2010-12-31$25,112
Administrative expenses (other) incurred2010-12-31$83,820
Liabilities. Value of operating payables at end of year2010-12-31$15,158
Liabilities. Value of operating payables at beginning of year2010-12-31$19,233
Total non interest bearing cash at end of year2010-12-31$287,078
Total non interest bearing cash at beginning of year2010-12-31$344,908
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-240,439
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,112,445
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$3,352,884
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$3,250,471
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$3,113,530
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$3,113,530
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$13,126
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$1,772,346
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,816,485
Employer contributions (assets) at end of year2010-12-31$22,082
Employer contributions (assets) at beginning of year2010-12-31$5,016
Contract administrator fees2010-12-31$74,086
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$162,676
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$2,000
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN2010-12-31910614823

Form 5500 Responses for WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN

2023: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entityMulitple employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entityMulitple employer plan
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: WASHINGTON STATE AUTO DEALERS INSURANCE TRUST BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered636
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $6,754
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $45,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4100800
Policy instance 8
Insurance contract or identification number4100800
Number of Individuals Covered121
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $712,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered646
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $38,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered595
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $1,388
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $13,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173543
Policy instance 4
Insurance contract or identification number000010173543
Number of Individuals Covered595
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $3,425
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $34,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered163
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $5,204
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $52,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered955
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,608,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered730
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $396,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered775
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,880,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered624
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $47,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered700
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $1,374
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $13,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,374
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered738
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $5,674
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $37,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,674
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173543
Policy instance 4
Insurance contract or identification number000010173543
Number of Individuals Covered700
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,276
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $32,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,276
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered170
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $4,373
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $43,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,373
Insurance broker organization code?3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered925
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $481,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4410080
Policy instance 8
Insurance contract or identification number4410080
Number of Individuals Covered206
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $950,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered738
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $7,488
Total amount of fees paid to insurance companyUSD $940
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $49,922
Commission paid to Insurance BrokerUSD $2,387
Insurance broker organization code?3
Amount paid for insurance broker fees940
Additional information about fees paid to insurance brokerBROKER BONUS
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered972
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $486,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered726
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $55,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173543
Policy instance 4
Insurance contract or identification number000010173543
Number of Individuals Covered688
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $4,159
Total amount of fees paid to insurance companyUSD $937
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $41,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,332
Insurance broker organization code?3
Amount paid for insurance broker fees937
Additional information about fees paid to insurance brokerBROKER BONUS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered171
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $5,343
Total amount of fees paid to insurance companyUSD $1,054
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $53,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,738
Insurance broker organization code?3
Amount paid for insurance broker fees1054
Additional information about fees paid to insurance brokerBROKER BONUS
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered851
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,584,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4410080
Policy instance 8
Insurance contract or identification number4410080
Number of Individuals Covered199
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,094,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered707
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $1,708
Total amount of fees paid to insurance companyUSD $332
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $17,082
Commission paid to Insurance BrokerUSD $601
Insurance broker organization code?3
Amount paid for insurance broker fees332
Additional information about fees paid to insurance brokerBROKER BONUS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered861
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $65,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered870
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $2,262
Total amount of fees paid to insurance companyUSD $240
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $22,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,262
Amount paid for insurance broker fees240
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered868
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $9,348
Total amount of fees paid to insurance companyUSD $434
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $62,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,348
Amount paid for insurance broker fees434
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173543
Policy instance 4
Insurance contract or identification number000010173543
Number of Individuals Covered867
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $6,437
Total amount of fees paid to insurance companyUSD $511
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $64,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,437
Amount paid for insurance broker fees511
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered184
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $6,964
Total amount of fees paid to insurance companyUSD $452
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $69,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,964
Amount paid for insurance broker fees452
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered951
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $7,038,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered848
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $532,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered1290
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $652,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered1337
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,926,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered230
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $5,759
Total amount of fees paid to insurance companyUSD $-1,438
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $57,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,759
Amount paid for insurance broker fees-1438
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173543
Policy instance 4
Insurance contract or identification number000010173543
Number of Individuals Covered1050
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $7,095
Total amount of fees paid to insurance companyUSD $-1,773
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $70,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,095
Amount paid for insurance broker fees-1773
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered1051
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $8,475
Total amount of fees paid to insurance companyUSD $-1,570
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $56,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,475
Amount paid for insurance broker fees-1570
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered1060
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $78,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered1051
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $2,085
Total amount of fees paid to insurance companyUSD $-425
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $20,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,085
Amount paid for insurance broker fees-425
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number4100800
Policy instance 8
Insurance contract or identification number4100800
Number of Individuals Covered252
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $572,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered1140
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $78,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered798
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $2,150
Total amount of fees paid to insurance companyUSD $1,756
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 CarrierUSD $21,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees424
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered798
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $11,748
Total amount of fees paid to insurance companyUSD $6,324
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $78,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1532
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number00400173542
Policy instance 5
Insurance contract or identification number00400173542
Number of Individuals Covered211
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $6,987
Total amount of fees paid to insurance companyUSD $5,711
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
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 CarrierUSD $69,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1353
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,987
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered1277
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $604,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number0000101743543
Policy instance 4
Insurance contract or identification number0000101743543
Number of Individuals Covered798
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $8,850
Total amount of fees paid to insurance companyUSD $7,204
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $88,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1763
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $0
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered1477
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $6,613,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered1052
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 2
Insurance contract or identification number000010173540
Number of Individuals Covered1037
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $2,629
Total amount of fees paid to insurance companyUSD $2,738
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,629
Amount paid for insurance broker fees913
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameMARK S. METTILLE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 3
Insurance contract or identification number000010173541
Number of Individuals Covered1035
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $14,478
Total amount of fees paid to insurance companyUSD $10,159
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,478
Amount paid for insurance broker fees3469
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameMARK S. METTILLE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number0000101743543
Policy instance 4
Insurance contract or identification number0000101743543
Number of Individuals Covered1035
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $10,707
Total amount of fees paid to insurance companyUSD $10,288
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,707
Amount paid for insurance broker fees3184
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameMARK S. METTILLE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 5
Insurance contract or identification number000400173542
Number of Individuals Covered263
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $8,671
Total amount of fees paid to insurance companyUSD $8,773
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $86,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,671
Amount paid for insurance broker fees2861
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameMARK S. METTILLE
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6766700
Policy instance 6
Insurance contract or identification number6766700
Number of Individuals Covered1638
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,792,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number09220
Policy instance 7
Insurance contract or identification number09220
Number of Individuals Covered1377
Insurance policy start date2016-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $745,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number100000046
Policy instance 2
Insurance contract or identification number100000046
Number of Individuals Covered1627
Insurance policy start date2015-01-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,936,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 3
Insurance contract or identification number000010173540
Number of Individuals Covered753
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $4,057
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,057
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 4
Insurance contract or identification number000010173541
Number of Individuals Covered753
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $21,822
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,822
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number0000101743543
Policy instance 5
Insurance contract or identification number0000101743543
Number of Individuals Covered753
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $12,330
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,330
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 6
Insurance contract or identification number000400173542
Number of Individuals Covered166
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $13,435
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $134,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,435
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered1217
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number0000101743543
Policy instance 5
Insurance contract or identification number0000101743543
Number of Individuals Covered713
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $5,105
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,105
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 4
Insurance contract or identification number000010173541
Number of Individuals Covered712
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $7,819
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,819
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 3
Insurance contract or identification number000010173540
Number of Individuals Covered711
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $474
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $474
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered982
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 6
Insurance contract or identification number000400173542
Number of Individuals Covered188
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $2,532
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $33,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,532
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number100000046
Policy instance 2
Insurance contract or identification number100000046
Number of Individuals Covered1401
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,317,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173545
Policy instance 8
Insurance contract or identification number000010173545
Number of Individuals Covered397
Insurance policy start date2013-02-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $13,267
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,267
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173547
Policy instance 9
Insurance contract or identification number000010173547
Number of Individuals Covered397
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $7,605
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,605
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173544
Policy instance 7
Insurance contract or identification number000010173544
Number of Individuals Covered402
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $939
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $939
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173542
Policy instance 6
Insurance contract or identification number000400173542
Number of Individuals Covered113
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $3,638
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,638
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number0000101743543
Policy instance 5
Insurance contract or identification number0000101743543
Number of Individuals Covered362
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $11,560
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,560
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173541
Policy instance 4
Insurance contract or identification number000010173541
Number of Individuals Covered366
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $17,067
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,067
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173540
Policy instance 3
Insurance contract or identification number000010173540
Number of Individuals Covered356
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $786
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $786
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number100000046
Policy instance 2
Insurance contract or identification number100000046
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,498,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered620
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173546
Policy instance 10
Insurance contract or identification number000400173546
Number of Individuals Covered59
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,399
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,399
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173548
Policy instance 11
Insurance contract or identification number000010173548
Number of Individuals Covered91
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $142
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173549
Policy instance 12
Insurance contract or identification number000010173549
Number of Individuals Covered93
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,449
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,449
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010173551
Policy instance 13
Insurance contract or identification number000010173551
Number of Individuals Covered93
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $679
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $679
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000400173550
Policy instance 14
Insurance contract or identification number000400173550
Number of Individuals Covered24
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $531
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOLUNTARY LIFE AND AD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $531
Insurance broker organization code?3
Insurance broker namePAYNEWEST INSURANCE, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number44349, ET AL
Policy instance 2
Insurance contract or identification number44349, ET AL
Number of Individuals Covered787
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $13,937
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $141,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,937
Insurance broker organization code?3
Insurance broker nameWESTERN STATE INSURANCE AGENCY
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number100000046
Policy instance 3
Insurance contract or identification number100000046
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,923,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012378
Policy instance 1
Insurance contract or identification number30012378
Number of Individuals Covered635
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number100000046
Policy instance 3
Insurance contract or identification number100000046
Number of Individuals Covered660
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $68,439
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,450,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number44349, ET AL
Policy instance 2
Insurance contract or identification number44349, ET AL
Number of Individuals Covered812
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number44349
Policy instance 3
Insurance contract or identification number44349
Number of Individuals Covered781
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $16,833
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $286,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012378
Policy instance 2
Insurance contract or identification number30012378
Number of Individuals Covered631
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )
Policy contract number921-922
Policy instance 1
Insurance contract or identification number921-922
Number of Individuals Covered348
Insurance policy start date2009-05-01
Insurance policy end date2010-04-30
Total amount of commissions paid to insurance brokerUSD $9,327
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $331,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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