401k Plan data: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST plan

HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 401k Plan overview

Plan Name	HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST
Plan identification number	501

HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

NORTHWEST FIRE FIGHTERS BENEFITS TRUST has sponsored the creation of one or more 401k plans.

Company Name: NORTHWEST FIRE FIGHTERS BENEFITS TRUST

Employer identification number (EIN): 461416156

NAIC Classification: 525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 KELLY FOX KELLY FOX 2016-10-16
501 2014-01-01 KELLY FOX KELLY FOX 2015-10-01
501 2013-01-01 KELLY FOX KELLY FOX 2014-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	KELLY FOX	KELLY FOX	2016-10-16
501	2014-01-01	KELLY FOX	KELLY FOX	2015-10-01
501	2013-01-01	KELLY FOX	KELLY FOX	2014-10-14

Plan Statistics for HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST

401k plan membership statisitcs for HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST

Measure Date Value
2015: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,137
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,054
Number of retired or separated participants receiving benefits 2015-01-01 188
Total of all active and inactive participants 2015-01-01 1,242
Number of employers contributing to the scheme 2015-01-01 23
2014: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 677
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 929
Number of retired or separated participants receiving benefits 2014-01-01 208
Total of all active and inactive participants 2014-01-01 1,137
Number of employers contributing to the scheme 2014-01-01 20
2013: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 538
Number of retired or separated participants receiving benefits 2013-01-01 139
Total of all active and inactive participants 2013-01-01 677

Measure	Date	Value
2015: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,137
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,054
Number of retired or separated participants receiving benefits	2015-01-01	188
Total of all active and inactive participants	2015-01-01	1,242
Number of employers contributing to the scheme	2015-01-01	23
2014: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	677
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	929
Number of retired or separated participants receiving benefits	2014-01-01	208
Total of all active and inactive participants	2014-01-01	1,137
Number of employers contributing to the scheme	2014-01-01	20
2013: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	538
Number of retired or separated participants receiving benefits	2013-01-01	139
Total of all active and inactive participants	2013-01-01	677

Financial Data on HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST

Measure	Date	Value
2015 : HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$123,082
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$317,651
Total income from all sources (including contributions)	2015-12-31	$20,376,963
Total of all expenses incurred	2015-12-31	$19,928,074
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$19,250,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$20,376,963
Value of total assets at end of year	2015-12-31	$703,849
Value of total assets at beginning of year	2015-12-31	$449,529
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$677,910
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$464,979
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$808,716
Participant contributions at end of year	2015-12-31	$2,460
Participant contributions at beginning of year	2015-12-31	$11,997
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$1,378
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$759
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$23,749
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$70,492
Administrative expenses (other) incurred	2015-12-31	$10,035
Liabilities. Value of operating payables at end of year	2015-12-31	$6,294
Liabilities. Value of operating payables at beginning of year	2015-12-31	$55,774
Total non interest bearing cash at end of year	2015-12-31	$193,693
Total non interest bearing cash at beginning of year	2015-12-31	$186,215
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$448,889
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$580,767
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$131,878
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$19,250,164
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$19,568,247
Employer contributions (assets) at end of year	2015-12-31	$506,318
Employer contributions (assets) at beginning of year	2015-12-31	$250,558
Contract administrator fees	2015-12-31	$202,896
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$93,039
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$191,385
Did the plan have assets held for investment	2015-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN	2015-12-31	910614823
2014 : HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$317,651
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$25,626
Total income from all sources (including contributions)	2014-12-31	$14,240,736
Total of all expenses incurred	2014-12-31	$14,170,848
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$13,697,769
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$14,240,736
Value of total assets at end of year	2014-12-31	$449,529
Value of total assets at beginning of year	2014-12-31	$87,616
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$473,079
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	$317,789
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
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	$396,725
Participant contributions at end of year	2014-12-31	$11,997
Participant contributions at beginning of year	2014-12-31	$1,126
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$759
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$706
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$70,492
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$1,314
Administrative expenses (other) incurred	2014-12-31	$14,396
Liabilities. Value of operating payables at end of year	2014-12-31	$55,774
Liabilities. Value of operating payables at beginning of year	2014-12-31	$5,829
Total non interest bearing cash at end of year	2014-12-31	$186,215
Total non interest bearing cash at beginning of year	2014-12-31	$27,656
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	$69,888
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$131,878
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$61,990
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
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$13,697,769
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	$13,844,011
Employer contributions (assets) at end of year	2014-12-31	$250,558
Employer contributions (assets) at beginning of year	2014-12-31	$58,128
Contract administrator fees	2014-12-31	$140,894
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$191,385
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$18,483
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	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	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN	2014-12-31	910614823
2013 : HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$25,626
Total income from all sources (including contributions)	2013-12-31	$8,209,748
Total of all expenses incurred	2013-12-31	$8,147,758
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$7,855,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$8,209,748
Value of total assets at end of year	2013-12-31	$87,616
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$292,629
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$200,348
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
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	$810,821
Participant contributions at end of year	2013-12-31	$1,126
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$706
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$1,314
Administrative expenses (other) incurred	2013-12-31	$7,057
Liabilities. Value of operating payables at end of year	2013-12-31	$5,829
Total non interest bearing cash at end of year	2013-12-31	$27,656
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	$61,990
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$61,990
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
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$7,855,129
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	$7,398,927
Employer contributions (assets) at end of year	2013-12-31	$58,128
Contract administrator fees	2013-12-31	$85,224
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$18,483
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	SCHOEDEL & SCHOEDEL, CPAS, PLLC
Accountancy firm EIN	2013-12-31	910614823

Form 5500 Responses for HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST

2015: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HEALTH AND WELFARE PLAN OF THE NORTHWEST FIRE FIGHTERS BENEFITS TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

3915 - 3922

Policy instance

Insurance contract or identification number	3915 - 3922
Number of Individuals Covered	1370
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
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $600,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000641

Policy instance

Insurance contract or identification number	40000641
Number of Individuals Covered	15
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $30
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000474

Policy instance

Insurance contract or identification number	40000474
Number of Individuals Covered	4
Insurance policy start date	2014-09-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $51
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

40000473

Policy instance

Insurance contract or identification number	40000473
Number of Individuals Covered	18
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $3,300
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,300
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

40000141

Policy instance

Insurance contract or identification number	40000141
Number of Individuals Covered	173
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
Welfare Benefit Premiums Paid to Carrier	USD $1,070,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

100000046

Policy instance

Insurance contract or identification number	100000046
Number of Individuals Covered	3595
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 $7,008
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,511,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7008
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000474

Policy instance

Insurance contract or identification number	40000474
Number of Individuals Covered	1
Insurance policy start date	2014-09-01
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

40000473

Policy instance

Insurance contract or identification number	40000473
Number of Individuals Covered	16
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,206
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,206
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

40000141

Policy instance

Insurance contract or identification number	40000141
Number of Individuals Covered	109
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $523,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

100000046

Policy instance

Insurance contract or identification number	100000046
Number of Individuals Covered	3052
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 $15,640
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,151,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	15640
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

100000046

Policy instance

Insurance contract or identification number	100000046
Number of Individuals Covered	628
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 $54,760
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,855,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	54760
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WASHINGTON, INC.

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Company Name:	NORTHWEST FIRE FIGHTERS BENEFITS TRUST
Employer identification number (EIN):	461416156
NAIC Classification:	525100
NAIC Description:	Insurance and Employee Benefit Funds