401k Plan data: MEDICAL EXPENSE COVERAGE PLAN plan

MEDICAL EXPENSE COVERAGE PLAN 401k Plan overview

Plan Name	MEDICAL EXPENSE COVERAGE PLAN
Plan identification number	505

MEDICAL EXPENSE COVERAGE PLAN Benefits

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

401k Sponsoring company profile

STANDARD INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: STANDARD INSURANCE COMPANY

Employer identification number (EIN): 930242990

NAIC Classification: 238210
NAIC Description: Electrical Contractors and Other Wiring Installation Contractors

Additional information about STANDARD INSURANCE COMPANY

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1981-08-26

Company Identification Number: 15532211

Legal Registered Office Address: 500 SW SUBLIMITY BLVD

SUBLIMITY
United States of America (USA)
97385

More information about STANDARD INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL EXPENSE COVERAGE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2015-01-01 BENJAMIN C. FRASIER
505 2014-01-01 BENJAMIN C FRASIER
505 2013-01-01 JUNG RYU
505 2012-01-01 JUNG RYU
505 2011-01-01 JUNG RYU
505 2009-01-01 JAMES TAFF

Plan id#	Filing Submission Date	Name of Administrator
505	2015-01-01	BENJAMIN C. FRASIER
505	2014-01-01	BENJAMIN C FRASIER
505	2013-01-01	JUNG RYU
505	2012-01-01	JUNG RYU
505	2011-01-01	JUNG RYU
505	2009-01-01	JAMES TAFF

Plan Statistics for MEDICAL EXPENSE COVERAGE PLAN

401k plan membership statisitcs for MEDICAL EXPENSE COVERAGE PLAN

Measure Date Value
2015: MEDICAL EXPENSE COVERAGE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
2014: MEDICAL EXPENSE COVERAGE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,674
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,503
Number of retired or separated participants receiving benefits 2014-01-01 278
Total of all active and inactive participants 2014-01-01 2,781
2013: MEDICAL EXPENSE COVERAGE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,839
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,377
Number of retired or separated participants receiving benefits 2013-01-01 297
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 2,674
Total participants 2013-01-01 2,674
2012: MEDICAL EXPENSE COVERAGE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,893
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,593
Number of retired or separated participants receiving benefits 2012-01-01 246
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 2,839
2011: MEDICAL EXPENSE COVERAGE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,962
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,655
Number of retired or separated participants receiving benefits 2011-01-01 238
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 2,893
2009: MEDICAL EXPENSE COVERAGE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3,179
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2,818
Number of retired or separated participants receiving benefits 2009-01-01 192
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 3,010

Measure	Date	Value
2015: MEDICAL EXPENSE COVERAGE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
2014: MEDICAL EXPENSE COVERAGE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,674
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,503
Number of retired or separated participants receiving benefits	2014-01-01	278
Total of all active and inactive participants	2014-01-01	2,781
2013: MEDICAL EXPENSE COVERAGE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,839
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,377
Number of retired or separated participants receiving benefits	2013-01-01	297
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	2,674
Total participants	2013-01-01	2,674
2012: MEDICAL EXPENSE COVERAGE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,893
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,593
Number of retired or separated participants receiving benefits	2012-01-01	246
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	2,839
2011: MEDICAL EXPENSE COVERAGE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,962
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,655
Number of retired or separated participants receiving benefits	2011-01-01	238
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	2,893
2009: MEDICAL EXPENSE COVERAGE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3,179
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,818
Number of retired or separated participants receiving benefits	2009-01-01	192
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	3,010

Financial Data on MEDICAL EXPENSE COVERAGE PLAN

Measure	Date	Value
2015 : MEDICAL EXPENSE COVERAGE PLAN 2015 401k financial data
Transfers to/from the plan	2015-01-01	$-20,884,364
Total plan liabilities at beginning of year	2015-01-01	$1,835,000
Total plan assets at end of year	2015-01-01	$0
Total plan assets at beginning of year	2015-01-01	$22,719,364
Net plan assets at end of year (total assets less liabilities)	2015-01-01	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-01-01	$20,884,364
2014 : MEDICAL EXPENSE COVERAGE PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$1,495,505
Total unrealized appreciation/depreciation of assets	2014-12-31	$1,495,505
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$1,835,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$1,587,000
Total income from all sources (including contributions)	2014-12-31	$28,414,135
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$26,512,186
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$26,437,353
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$26,089,619
Value of total assets at end of year	2014-12-31	$22,719,364
Value of total assets at beginning of year	2014-12-31	$20,569,415
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$74,833
Total interest from all sources	2014-12-31	$829,011
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$11,313
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$7,796,606
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$177,377
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$182,032
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$1,835,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$1,587,000
Administrative expenses (other) incurred	2014-12-31	$63,520
Total non interest bearing cash at end of year	2014-12-31	$1,011
Total non interest bearing cash at beginning of year	2014-12-31	$1,001
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,901,949
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$20,884,364
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$18,982,415
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Income. Interest from US Government securities	2014-12-31	$829,011
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$516,226
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$556,265
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$556,265
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$10,315,837
Asset value of US Government securities at end of year	2014-12-31	$17,921,836
Asset value of US Government securities at beginning of year	2014-12-31	$16,793,624
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$18,293,013
Employer contributions (assets) at end of year	2014-12-31	$1,492,719
Employer contributions (assets) at beginning of year	2014-12-31	$1,288,873
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$16,121,516
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$2,610,195
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$1,747,620
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2014-12-31	910189318
2013 : MEDICAL EXPENSE COVERAGE PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$-1,799,707
Total unrealized appreciation/depreciation of assets	2013-12-31	$-1,799,707
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$1,587,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$1,569,000
Total income from all sources (including contributions)	2013-12-31	$23,897,691
Total loss/gain on sale of assets	2013-12-31	$8,496
Total of all expenses incurred	2013-12-31	$26,201,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$26,201,377
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$24,864,406
Value of total assets at end of year	2013-12-31	$20,569,415
Value of total assets at beginning of year	2013-12-31	$22,855,101
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$824,496
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$7,456,826
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$684,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$182,032
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$173,004
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$1,587,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$1,569,000
Total non interest bearing cash at end of year	2013-12-31	$1,001
Total non interest bearing cash at beginning of year	2013-12-31	$1,009
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-2,303,686
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$18,982,415
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$21,286,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Income. Interest from US Government securities	2013-12-31	$823,938
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$556,265
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$1,382,610
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$1,382,610
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$558
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$9,673,980
Asset value of US Government securities at end of year	2013-12-31	$16,793,624
Asset value of US Government securities at beginning of year	2013-12-31	$19,029,326
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$17,407,580
Employer contributions (assets) at end of year	2013-12-31	$1,288,873
Employer contributions (assets) at beginning of year	2013-12-31	$1,264,762
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$15,843,397
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$1,747,620
Asset. Corporate debt instrument debt (other) at beginning of year	2013-12-31	$1,004,390
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$693,496
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$685,000
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	DELOITTE & TOUCHE, LLP
Accountancy firm EIN	2013-12-31	133891517
2012 : MEDICAL EXPENSE COVERAGE PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$341,570
Total unrealized appreciation/depreciation of assets	2012-12-31	$341,570
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,569,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,835,000
Total income from all sources (including contributions)	2012-12-31	$25,628,805
Total loss/gain on sale of assets	2012-12-31	$14,807
Total of all expenses incurred	2012-12-31	$24,808,274
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$24,808,274
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$24,431,896
Value of total assets at end of year	2012-12-31	$22,855,101
Value of total assets at beginning of year	2012-12-31	$22,300,570
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$840,532
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$7,475,173
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$173,004
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$182,919
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$1,569,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$1,835,000
Total non interest bearing cash at end of year	2012-12-31	$1,009
Total non interest bearing cash at beginning of year	2012-12-31	$236,702
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$820,531
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$21,286,101
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$20,465,570
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Income. Interest from US Government securities	2012-12-31	$839,992
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$1,382,610
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$540
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$9,327,143
Asset value of US Government securities at end of year	2012-12-31	$19,029,326
Asset value of US Government securities at beginning of year	2012-12-31	$20,277,150
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$16,956,723
Employer contributions (assets) at end of year	2012-12-31	$1,264,762
Employer contributions (assets) at beginning of year	2012-12-31	$1,603,799
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$15,481,131
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$1,004,390
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$824,000
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$809,193
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	DELOITTE & TOUCHE, LLP
Accountancy firm EIN	2012-12-31	133891517
2011 : MEDICAL EXPENSE COVERAGE PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$1,867,405
Total unrealized appreciation/depreciation of assets	2011-12-31	$1,867,405
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,835,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,885,000
Total income from all sources (including contributions)	2011-12-31	$28,347,356
Total loss/gain on sale of assets	2011-12-31	$604
Total of all expenses incurred	2011-12-31	$25,938,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$25,938,946
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$25,657,245
Value of total assets at end of year	2011-12-31	$22,300,570
Value of total assets at beginning of year	2011-12-31	$19,942,160
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$822,102
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$7,629,822
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$182,919
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$161,423
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$1,835,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$1,885,000
Total non interest bearing cash at end of year	2011-12-31	$236,702
Total non interest bearing cash at beginning of year	2011-12-31	$961,267
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$2,408,410
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$20,465,570
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$18,057,160
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Income. Interest from US Government securities	2011-12-31	$821,345
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$757
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$9,336,665
Asset value of US Government securities at end of year	2011-12-31	$20,277,150
Asset value of US Government securities at beginning of year	2011-12-31	$17,067,042
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$18,027,423
Employer contributions (assets) at end of year	2011-12-31	$1,603,799
Employer contributions (assets) at beginning of year	2011-12-31	$1,752,428
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$16,602,281
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$1,085,000
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$1,084,396
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	DELOITTE & TOUCHE, LLP
Accountancy firm EIN	2011-12-31	133891517
2010 : MEDICAL EXPENSE COVERAGE PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$-595,316
Total unrealized appreciation/depreciation of assets	2010-12-31	$-595,316
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,885,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,912,000
Total income from all sources (including contributions)	2010-12-31	$24,996,440
Total loss/gain on sale of assets	2010-12-31	$634
Total of all expenses incurred	2010-12-31	$24,952,947
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$24,952,947
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$24,779,532
Value of total assets at end of year	2010-12-31	$19,942,160
Value of total assets at beginning of year	2010-12-31	$19,898,667
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$811,590
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$20,000,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$7,473,872
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$-53,030
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$161,423
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$186,530
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$1,885,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,912,000
Total non interest bearing cash at end of year	2010-12-31	$961,267
Total non interest bearing cash at beginning of year	2010-12-31	$347,113
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$43,493
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$18,057,160
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$17,986,667
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Income. Interest from US Government securities	2010-12-31	$809,691
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1,899
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$9,699,837
Asset value of US Government securities at end of year	2010-12-31	$17,067,042
Asset value of US Government securities at beginning of year	2010-12-31	$17,607,579
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$17,305,660
Employer contributions (assets) at end of year	2010-12-31	$1,752,428
Employer contributions (assets) at beginning of year	2010-12-31	$1,757,445
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$15,306,140
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$4,400,000
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$4,399,366
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	DELOITTE & TOUCHE, LLP
Accountancy firm EIN	2010-12-31	133891517

Form 5500 Responses for MEDICAL EXPENSE COVERAGE PLAN

2015: MEDICAL EXPENSE COVERAGE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MEDICAL EXPENSE COVERAGE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MEDICAL EXPENSE COVERAGE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MEDICAL EXPENSE COVERAGE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MEDICAL EXPENSE COVERAGE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: MEDICAL EXPENSE COVERAGE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	1984
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,870
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $10,380,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	5870
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE INC.

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	33
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $158,678

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	33
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $130,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	1978
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $10,529,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	34
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $149,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	2079
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,566
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $9,327,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2566
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON PENNSYLVANIA INC

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	29
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $140,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	1009
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,589
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $9,330,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1876

Policy instance

Insurance contract or identification number	1876
Number of Individuals Covered	1020
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,563
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $8,861,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100573

Policy instance

Insurance contract or identification number	100573
Number of Individuals Covered	26
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $125,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )

Policy contract number

376413

Policy instance

Insurance contract or identification number	376413
Number of Individuals Covered	47
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $15,402
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $814,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	STANDARD INSURANCE COMPANY
Employer identification number (EIN):	930242990
NAIC Classification:	238210
NAIC Description:	Electrical Contractors and Other Wiring Installation Contractors

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1981-08-26
Company Identification Number:	15532211
Legal Registered Office Address:	500 SW SUBLIMITY BLVD SUBLIMITY United States of America (USA) 97385