THE TRUSTEES OF THE EMPLOYEE BENEFITS TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AWB HEALTHCHOICE EMPLOYEE BENEFITS TRUST - TECHNOLOGY
| Measure | Date | Value |
|---|
| 2023 : AWB HEALTHCHOICE EMPLOYEE BENEFITS TRUST - TECHNOLOGY 2023 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2023-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $73,649 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $113,673 |
| Total income from all sources (including contributions) | 2023-12-31 | $7,616,705 |
| Total loss/gain on sale of assets | 2023-12-31 | $-1,466 |
| Total of all expenses incurred | 2023-12-31 | $7,485,114 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $7,405,491 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $7,554,178 |
| Value of total assets at end of year | 2023-12-31 | $1,505,991 |
| Value of total assets at beginning of year | 2023-12-31 | $1,414,424 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $79,623 |
| Total interest from all sources | 2023-12-31 | $29,665 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-12-31 | $1,497 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $52,026 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $6,577 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $174,425 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-12-31 | $15,547 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-12-31 | $1,013 |
| Administrative expenses (other) incurred | 2023-12-31 | $13,686 |
| Liabilities. Value of operating payables at end of year | 2023-12-31 | $2,802 |
| Liabilities. Value of operating payables at beginning of year | 2023-12-31 | $72 |
| Total non interest bearing cash at end of year | 2023-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $342,509 |
| Value of net income/loss | 2023-12-31 | $131,591 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $1,432,342 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $1,300,751 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-12-31 | $100,737 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-12-31 | $89,790 |
| Income. Interest from US Government securities | 2023-12-31 | $15,428 |
| Income. Interest from corporate debt instruments | 2023-12-31 | $9,994 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-12-31 | $562,819 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-12-31 | $22,550 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-12-31 | $22,550 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-12-31 | $4,243 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $7,405,491 |
| Asset value of US Government securities at end of year | 2023-12-31 | $422,625 |
| Asset value of US Government securities at beginning of year | 2023-12-31 | $586,250 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-12-31 | $32,831 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $7,502,152 |
| Income. Dividends from preferred stock | 2023-12-31 | $1,497 |
| Asset. Corporate debt instrument preferred debt at end of year | 2023-12-31 | $413,233 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2023-12-31 | $198,900 |
| Contract administrator fees | 2023-12-31 | $60,825 |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $55,300 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $112,588 |
| Did the plan have assets held for investment | 2023-12-31 | Yes |
| Aggregate proceeds on sale of assets | 2023-12-31 | $525,722 |
| Aggregate carrying amount (costs) on sale of assets | 2023-12-31 | $527,188 |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | CLIFTONLARSONALLEN |
| Accountancy firm EIN | 2023-12-31 | 410746749 |
| Total unrealized appreciation/depreciation of assets | 2023-01-01 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-01-01 | $73,649 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-01-01 | $113,673 |
| Total income from all sources (including contributions) | 2023-01-01 | $7,616,705 |
| Total loss/gain on sale of assets | 2023-01-01 | $-1,466 |
| Total of all expenses incurred | 2023-01-01 | $7,485,114 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-01-01 | $7,405,491 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-01-01 | $7,554,178 |
| Value of total assets at end of year | 2023-01-01 | $1,505,991 |
| Value of total assets at beginning of year | 2023-01-01 | $1,414,424 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-01-01 | $79,623 |
| Total interest from all sources | 2023-01-01 | $29,665 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-01-01 | $1,497 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-01-01 | No |
| Contributions received from participants | 2023-01-01 | $52,026 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-01-01 | $6,577 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-01-01 | $174,425 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-01-01 | $15,547 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-01-01 | $1,013 |
| Administrative expenses (other) incurred | 2023-01-01 | $13,686 |
| Liabilities. Value of operating payables at end of year | 2023-01-01 | $2,802 |
| Liabilities. Value of operating payables at beginning of year | 2023-01-01 | $72 |
| Total non interest bearing cash at end of year | 2023-01-01 | $0 |
| Total non interest bearing cash at beginning of year | 2023-01-01 | $342,509 |
| Value of net income/loss | 2023-01-01 | $131,591 |
| Value of net assets at end of year (total assets less liabilities) | 2023-01-01 | $1,432,342 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-01-01 | $1,300,751 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-01-01 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-01-01 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-01-01 | $100,737 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-01-01 | $89,790 |
| Income. Interest from US Government securities | 2023-01-01 | $15,428 |
| Income. Interest from corporate debt instruments | 2023-01-01 | $9,994 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-01-01 | $562,819 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-01-01 | $4,243 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-01-01 | $7,405,491 |
| Asset value of US Government securities at end of year | 2023-01-01 | $422,625 |
| Asset value of US Government securities at beginning of year | 2023-01-01 | $586,250 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-01-01 | $32,831 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-01-01 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-01-01 | No |
| Contributions received in cash from employer | 2023-01-01 | $7,502,152 |
| Income. Dividends from preferred stock | 2023-01-01 | $1,497 |
| Asset. Corporate debt instrument preferred debt at end of year | 2023-01-01 | $413,233 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2023-01-01 | $198,900 |
| Contract administrator fees | 2023-01-01 | $60,825 |
| Liabilities. Value of benefit claims payable at end of year | 2023-01-01 | $55,300 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-01-01 | $112,588 |
| Did the plan have assets held for investment | 2023-01-01 | Yes |
| Aggregate proceeds on sale of assets | 2023-01-01 | $525,722 |
| Aggregate carrying amount (costs) on sale of assets | 2023-01-01 | $527,188 |
| Opinion of an independent qualified public accountant for this plan | 2023-01-01 | 1 |
| Accountancy firm name | 2023-01-01 | CLIFTONLARSONALLEN |
| Accountancy firm EIN | 2023-01-01 | 410746749 |
| 2022 : AWB HEALTHCHOICE EMPLOYEE BENEFITS TRUST - TECHNOLOGY 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $113,672 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $137,133 |
| Total income from all sources (including contributions) | 2022-12-31 | $8,119,720 |
| Total loss/gain on sale of assets | 2022-12-31 | $-92 |
| Total of all expenses incurred | 2022-12-31 | $8,120,538 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $8,033,226 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $8,135,406 |
| Value of total assets at end of year | 2022-12-31 | $1,414,423 |
| Value of total assets at beginning of year | 2022-12-31 | $1,438,702 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $87,312 |
| Total interest from all sources | 2022-12-31 | $14,043 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $1,362 |
| Administrative expenses professional fees incurred | 2022-12-31 | $13,791 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $174,425 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $163,323 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $1,012 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $5,669 |
| Other income not declared elsewhere | 2022-12-31 | $600 |
| Administrative expenses (other) incurred | 2022-12-31 | $2,549 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $72 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $749 |
| Total non interest bearing cash at end of year | 2022-12-31 | $342,509 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $1,275,379 |
| Value of net income/loss | 2022-12-31 | $-818 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $1,300,751 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,301,569 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $89,790 |
| Income. Interest from US Government securities | 2022-12-31 | $9,553 |
| Income. Interest from corporate debt instruments | 2022-12-31 | $3,125 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $22,549 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $1,365 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $8,033,226 |
| Asset value of US Government securities at end of year | 2022-12-31 | $586,250 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-31,599 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $8,135,406 |
| Income. Dividends from preferred stock | 2022-12-31 | $1,362 |
| Asset. Corporate debt instrument preferred debt at end of year | 2022-12-31 | $198,900 |
| Contract administrator fees | 2022-12-31 | $70,972 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $112,588 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $130,715 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Aggregate proceeds on sale of assets | 2022-12-31 | $1,238,747 |
| Aggregate carrying amount (costs) on sale of assets | 2022-12-31 | $1,238,839 |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2022-12-31 | 410746749 |
| Total unrealized appreciation/depreciation of assets | 2022-01-01 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-01 | $113,672 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-01 | $137,133 |
| Total income from all sources (including contributions) | 2022-01-01 | $8,119,720 |
| Total loss/gain on sale of assets | 2022-01-01 | $-92 |
| Total of all expenses incurred | 2022-01-01 | $8,120,538 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-01-01 | $8,033,226 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-01-01 | $8,135,406 |
| Value of total assets at end of year | 2022-01-01 | $1,414,423 |
| Value of total assets at beginning of year | 2022-01-01 | $1,438,702 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-01-01 | $87,312 |
| Total interest from all sources | 2022-01-01 | $14,043 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-01-01 | $1,362 |
| Administrative expenses professional fees incurred | 2022-01-01 | $13,791 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-01-01 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-01-01 | $174,425 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-01-01 | $163,323 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-01-01 | $1,012 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-01-01 | $5,669 |
| Other income not declared elsewhere | 2022-01-01 | $600 |
| Administrative expenses (other) incurred | 2022-01-01 | $2,549 |
| Liabilities. Value of operating payables at end of year | 2022-01-01 | $72 |
| Liabilities. Value of operating payables at beginning of year | 2022-01-01 | $749 |
| Total non interest bearing cash at end of year | 2022-01-01 | $342,509 |
| Total non interest bearing cash at beginning of year | 2022-01-01 | $1,275,379 |
| Value of net income/loss | 2022-01-01 | $-818 |
| Value of net assets at end of year (total assets less liabilities) | 2022-01-01 | $1,300,751 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-01-01 | $1,301,569 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-01-01 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-01-01 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-01-01 | $89,790 |
| Income. Interest from US Government securities | 2022-01-01 | $9,553 |
| Income. Interest from corporate debt instruments | 2022-01-01 | $3,125 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-01-01 | $22,549 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-01-01 | $1,365 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-01-01 | $8,033,226 |
| Asset value of US Government securities at end of year | 2022-01-01 | $586,250 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-01-01 | $-31,599 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-01-01 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-01-01 | No |
| Contributions received in cash from employer | 2022-01-01 | $8,135,406 |
| Income. Dividends from preferred stock | 2022-01-01 | $1,362 |
| Asset. Corporate debt instrument preferred debt at end of year | 2022-01-01 | $198,900 |
| Contract administrator fees | 2022-01-01 | $70,972 |
| Liabilities. Value of benefit claims payable at end of year | 2022-01-01 | $112,588 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-01-01 | $130,715 |
| Did the plan have assets held for investment | 2022-01-01 | Yes |
| Aggregate proceeds on sale of assets | 2022-01-01 | $1,238,747 |
| Aggregate carrying amount (costs) on sale of assets | 2022-01-01 | $1,238,839 |
| Opinion of an independent qualified public accountant for this plan | 2022-01-01 | 1 |
| Accountancy firm name | 2022-01-01 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2022-01-01 | 410746749 |
| 2021 : AWB HEALTHCHOICE EMPLOYEE BENEFITS TRUST - TECHNOLOGY 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total transfer of assets to this plan | 2021-12-31 | $1,317,401 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $137,133 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $0 |
| Total income from all sources (including contributions) | 2021-12-31 | $8,614,308 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $8,630,140 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $8,234,145 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $8,612,601 |
| Value of total assets at end of year | 2021-12-31 | $1,438,702 |
| Value of total assets at beginning of year | 2021-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $395,995 |
| Total interest from all sources | 2021-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $0 |
| Administrative expenses professional fees incurred | 2021-12-31 | $235,131 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $163,323 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $5,669 |
| Other income not declared elsewhere | 2021-12-31 | $1,707 |
| Administrative expenses (other) incurred | 2021-12-31 | $3,315 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $749 |
| Total non interest bearing cash at end of year | 2021-12-31 | $1,275,379 |
| Value of net income/loss | 2021-12-31 | $-15,832 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $1,301,569 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $8,234,145 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $8,612,601 |
| Contract administrator fees | 2021-12-31 | $157,549 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $130,715 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | FROST & COMPANY PLLC |
| Accountancy firm EIN | 2021-12-31 | 275137616 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 122482630016-19 |
| Policy instance | 2 |
| Insurance contract or identification number | 122482630016-19 | | Number of Individuals Covered | 726 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $31,778 | | 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 number | 100000148 |
| Policy instance | 1 |
| Insurance contract or identification number | 100000148 | | Number of Individuals Covered | 729 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 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 $6,983,343 | | 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: 65676 ) |
| Policy contract number | 168475-6,168505 |
| Policy instance | 6 |
| Insurance contract or identification number | 168475-6,168505 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | 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 Carrier | USD $29,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
| Policy contract number | 09450-09457 |
| Policy instance | 5 |
| Insurance contract or identification number | 09450-09457 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0234392 |
| Policy instance | 4 |
| Insurance contract or identification number | 0234392 | | Number of Individuals Covered | 720 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | 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 Carrier | USD $14,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
| Policy contract number | WA385 |
| Policy instance | 3 |
| Insurance contract or identification number | WA385 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
| Policy contract number | WA385 |
| Policy instance | 6 |
| Insurance contract or identification number | WA385 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 122482630016-19 |
| Policy instance | 5 |
| Insurance contract or identification number | 122482630016-19 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
| Policy contract number | 09450-09457 |
| Policy instance | 4 |
| Insurance contract or identification number | 09450-09457 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0234392 |
| Policy instance | 3 |
| Insurance contract or identification number | 0234392 | | Number of Individuals Covered | 662 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | 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 Carrier | USD $16,620 | | 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: 65676 ) |
| Policy contract number | 168475-6,168505 |
| Policy instance | 2 |
| Insurance contract or identification number | 168475-6,168505 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | 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 Carrier | USD $29,642 | | 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 number | 100000148 |
| Policy instance | 1 |
| Insurance contract or identification number | 100000148 | | Number of Individuals Covered | 666 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 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 $7,503,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0234392 |
| Policy instance | 7 |
| PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 ) |
| Policy contract number | 100000148 |
| Policy instance | 6 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50020272 |
| Policy instance | 5 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
| Policy contract number | 122482630016-19 |
| Policy instance | 4 |
| DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
| Policy contract number | 09450-09457 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 168475-6,168505 |
| Policy instance | 2 |
| WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 ) |
| Policy contract number | WA385 |
| Policy instance | 1 |
