401k Plan data: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION plan

HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 401k Plan overview

Plan Name	HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION
Plan identification number	501

HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GUIDEHOUSE MANAGED SERVICES LLC has sponsored the creation of one or more 401k plans.

Company Name: GUIDEHOUSE MANAGED SERVICES LLC

Employer identification number (EIN): 202858838

NAIC Classification: 541600

Additional information about GUIDEHOUSE MANAGED SERVICES LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3949070

More information about GUIDEHOUSE MANAGED SERVICES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 MICHAEL HALBERDA
501 2014-01-01 MICHAEL HALBERDA
501 2013-01-01 MICHAEL HALBERDA
501 2012-01-01 MICHAEL HALBERDA
501 2011-01-01 MICHAEL HALBERDA
501 2009-01-01 JEFFREY MACDONALD CFO
501 2009-01-01 MICHAEL HALBERDA
501 2009-01-01 JEFFREY MACDONALD CFO
501 2009-01-01 JEFFREY MACDONALD CFO

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	MICHAEL HALBERDA
501	2014-01-01	MICHAEL HALBERDA
501	2013-01-01	MICHAEL HALBERDA
501	2012-01-01	MICHAEL HALBERDA
501	2011-01-01	MICHAEL HALBERDA
501	2009-01-01	JEFFREY MACDONALD CFO
501	2009-01-01	MICHAEL HALBERDA
501	2009-01-01	JEFFREY MACDONALD CFO
501	2009-01-01	JEFFREY MACDONALD CFO

Plan Statistics for HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION

401k plan membership statisitcs for HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION

Measure Date Value
2015: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2015 401k membership
Total participants, beginning-of-year 2015-01-01 737
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 757
Number of retired or separated participants receiving benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 758
Total participants 2015-01-01 0
2014: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2014 401k membership
Total participants, beginning-of-year 2014-01-01 702
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 737
Total of all active and inactive participants 2014-01-01 737
Total participants 2014-01-01 0
2013: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2013 401k membership
Total participants, beginning-of-year 2013-01-01 532
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 612
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 87
Total of all active and inactive participants 2013-01-01 702
Total participants 2013-01-01 0
2012: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 479
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 532
Total of all active and inactive participants 2012-01-01 532
Total participants 2012-01-01 0
2011: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 437
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 479
Total of all active and inactive participants 2011-01-01 479
Total participants 2011-01-01 479
2009: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2009 401k membership
Total participants, beginning-of-year 2009-01-01 269
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 439
Number of retired or separated participants receiving benefits 2009-01-01 8
Number of other retired or separated participants entitled to future benefits 2009-01-01 24
Total of all active and inactive participants 2009-01-01 471
Total participants 2009-01-01 471

Measure	Date	Value
2015: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2015 401k membership
Total participants, beginning-of-year	2015-01-01	737
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	757
Number of retired or separated participants receiving benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	758
Total participants	2015-01-01	0
2014: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2014 401k membership
Total participants, beginning-of-year	2014-01-01	702
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	737
Total of all active and inactive participants	2014-01-01	737
Total participants	2014-01-01	0
2013: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2013 401k membership
Total participants, beginning-of-year	2013-01-01	532
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	612
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	87
Total of all active and inactive participants	2013-01-01	702
Total participants	2013-01-01	0
2012: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	479
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	532
Total of all active and inactive participants	2012-01-01	532
Total participants	2012-01-01	0
2011: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	437
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	479
Total of all active and inactive participants	2011-01-01	479
Total participants	2011-01-01	479
2009: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2009 401k membership
Total participants, beginning-of-year	2009-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	439
Number of retired or separated participants receiving benefits	2009-01-01	8
Number of other retired or separated participants entitled to future benefits	2009-01-01	24
Total of all active and inactive participants	2009-01-01	471
Total participants	2009-01-01	471

Form 5500 Responses for HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION

2015: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 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	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF CYMETRIX CORPORATION 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95003 )

Policy contract number

0804829HNO

Policy instance

Insurance contract or identification number	0804829HNO
Number of Individuals Covered	172
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $29,162
Welfare Benefit Premiums Paid to Carrier	USD $714,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,162
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 )

Policy contract number

5925296

Policy instance

Insurance contract or identification number	5925296
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $312
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $312
Insurance broker organization code?	3
Insurance broker name	BENEFIT EXCHANGES ALLIANCE INC

SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 )

Policy contract number

5925296

Policy instance

Insurance contract or identification number	5925296
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,936
Total amount of fees paid to insurance company	USD $1,223
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,936
Amount paid for insurance broker fees	1223
Additional information about fees paid to insurance broker	ADMIN FEES
Insurance broker organization code?	3
Insurance broker name	BENEFIT EXCHANGES ALLIANCE INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0804829

Policy instance

Insurance contract or identification number	0804829
Number of Individuals Covered	622
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $175,415
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,186,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $175,415
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5925296

Policy instance

Insurance contract or identification number	5925296
Number of Individuals Covered	1108
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $40,566
Total amount of fees paid to insurance company	USD $25,626
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $523,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,566
Amount paid for insurance broker fees	25626
Additional information about fees paid to insurance broker	ADMIN FEES, NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BENEFIT EXCHANGES ALLIANCE INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

231100

Policy instance

Insurance contract or identification number	231100
Number of Individuals Covered	249
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $38,271
Welfare Benefit Premiums Paid to Carrier	USD $889,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,271
Insurance broker organization code?	3
Insurance broker name	BXA INSURANCE SERVICES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD089E3

Policy instance

Insurance contract or identification number	GLTD089E3
Number of Individuals Covered	655
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,015
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,015
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG089E3

Policy instance

Insurance contract or identification number	GLUG089E3
Number of Individuals Covered	650
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,239
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,239
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30026753

Policy instance

Insurance contract or identification number	30026753
Number of Individuals Covered	568
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,004
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,004
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

836338-000

Policy instance

Insurance contract or identification number	836338-000
Number of Individuals Covered	520
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $21,588
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $251,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,588
Insurance broker organization code?	3
Insurance broker name	BENEFIT EXCHANGE ALLIANCE, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL089E3

Policy instance

Insurance contract or identification number	GVTL089E3
Number of Individuals Covered	167
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,429
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,429
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

231100

Policy instance

Insurance contract or identification number	231100
Number of Individuals Covered	168
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $29,184
Welfare Benefit Premiums Paid to Carrier	USD $737,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,184
Insurance broker organization code?	3
Insurance broker name	BXA INSURANCE SERVICES

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95003 )

Policy contract number

0804829HNO

Policy instance

Insurance contract or identification number	0804829HNO
Number of Individuals Covered	142
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $24,371
Welfare Benefit Premiums Paid to Carrier	USD $595,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,371
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0804829

Policy instance

Insurance contract or identification number	0804829
Number of Individuals Covered	563
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $128,339
Total amount of fees paid to insurance company	USD $22,157
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,256,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,339
Amount paid for insurance broker fees	22157
Additional information about fees paid to insurance broker	2013/2014 MM P3 BONUS
Insurance broker organization code?	3
Insurance broker name	PENBEN FINANCIAL SERVICES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3772795

Policy instance

Insurance contract or identification number	E3772795
Number of Individuals Covered	251
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $36,207
Total amount of fees paid to insurance company	USD $6,429
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $271,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,617
Amount paid for insurance broker fees	753
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	MARK A SHELL

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

836338-001

Policy instance

Insurance contract or identification number	836338-001
Number of Individuals Covered	398
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,741
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,741
Insurance broker organization code?	3
Insurance broker name	BENEFIT EXCHANGE ALLIANCE, INC.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0837596

Policy instance

Insurance contract or identification number	0837596
Number of Individuals Covered	96
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $399,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

970303

Policy instance

Insurance contract or identification number	970303
Number of Individuals Covered	533
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $58,724
Total amount of fees paid to insurance company	USD $15,643
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,468,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,852
Insurance broker organization code?	3
Amount paid for insurance broker fees	15643
Additional information about fees paid to insurance broker	BONUS OVERRIDE ALLOCATION
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3772795

Policy instance

Insurance contract or identification number	E3772795
Number of Individuals Covered	328
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $55,281
Total amount of fees paid to insurance company	USD $13,046
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $263,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,362
Amount paid for insurance broker fees	2467
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	JOE FERNANDEZ

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30026753

Policy instance

Insurance contract or identification number	30026753
Number of Individuals Covered	522
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,268
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,188
Insurance broker organization code?	3
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

231100

Policy instance

Insurance contract or identification number	231100
Number of Individuals Covered	145
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $24,342
Welfare Benefit Premiums Paid to Carrier	USD $665,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,171
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL089E3

Policy instance

Insurance contract or identification number	GVTL089E3
Number of Individuals Covered	161
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,601
Total amount of fees paid to insurance company	USD $2,493
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,891
Insurance broker organization code?	3
Amount paid for insurance broker fees	2493
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	ROBERT C. PLACAK & ASSOICATES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD089E3

Policy instance

Insurance contract or identification number	GLTD089E3
Number of Individuals Covered	549
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,337
Total amount of fees paid to insurance company	USD $2,104
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,682
Insurance broker organization code?	3
Amount paid for insurance broker fees	2104
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

836338-001

Policy instance

Insurance contract or identification number	836338-001
Number of Individuals Covered	272
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,520
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,933
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

836338-000

Policy instance

Insurance contract or identification number	836338-000
Number of Individuals Covered	424
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $16,879
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $228,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,196
Insurance broker organization code?	3
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG089E3

Policy instance

Insurance contract or identification number	GLUG089E3
Number of Individuals Covered	549
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,422
Total amount of fees paid to insurance company	USD $538
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,820
Insurance broker organization code?	3
Amount paid for insurance broker fees	538
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD089E3

Policy instance

Insurance contract or identification number	GLTD089E3
Number of Individuals Covered	491
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,632
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,632
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

970303

Policy instance

Insurance contract or identification number	970303
Number of Individuals Covered	310
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $106,856
Total amount of fees paid to insurance company	USD $15,643
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,604,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,887
Amount paid for insurance broker fees	15643
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3772795

Policy instance

Insurance contract or identification number	E3772795
Number of Individuals Covered	272
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $71,633
Total amount of fees paid to insurance company	USD $20,611
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $269,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Amount paid for insurance broker fees	8
Insurance broker name	CLIENT BENEFIT INSURANCE SERVICES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30026753

Policy instance

Insurance contract or identification number	30026753
Number of Individuals Covered	480
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4,491
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,329
Insurance broker organization code?	3
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

231100

Policy instance

Insurance contract or identification number	231100
Number of Individuals Covered	127
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $22,232
Welfare Benefit Premiums Paid to Carrier	USD $595,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,945
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL089E3

Policy instance

Insurance contract or identification number	GVTL089E3
Number of Individuals Covered	164
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,366
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,366
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOICATES

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

712482

Policy instance

Insurance contract or identification number	712482
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Number of Individuals Covered	493
Total amount of commissions paid to insurance broker	USD $86,429
Welfare Benefit Premiums Paid to Carrier	USD $1,347,092
Commission paid to Insurance Broker	USD $86,429
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG089E3

Policy instance

Insurance contract or identification number	GLUG089E3
Number of Individuals Covered	489
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,664
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,664
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

836338-001

Policy instance

Insurance contract or identification number	836338-001
Number of Individuals Covered	278
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Total amount of commissions paid to insurance broker	USD $5,527
Commission paid to Insurance Broker	USD $5,527
Insurance broker organization code?	3
Insurance broker name	ROBERT C. PLACAK & ASSOCIATES

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

836338-000

Policy instance

Insurance contract or identification number	836338-000
Number of Individuals Covered	468
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $210,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Total amount of commissions paid to insurance broker	USD $21,664
Commission paid to Insurance Broker	USD $21,664
Insurance broker organization code?	3
Insurance broker name	ROBERT C PLACAK & ASSOCIATES

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3772795

Policy instance

Insurance contract or identification number	E3772795
Number of Individuals Covered	224
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $113,986
Total amount of fees paid to insurance company	USD $16,146
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $235,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

231100

Policy instance

Insurance contract or identification number	231100
Number of Individuals Covered	123
Insurance policy start date	2011-07-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $13,105
Welfare Benefit Premiums Paid to Carrier	USD $246,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL089E3

Policy instance

Insurance contract or identification number	GVTL089E3
Number of Individuals Covered	171
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,680
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

836338-000

Policy instance

Insurance contract or identification number	836338-000
Number of Individuals Covered	339
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $26,198
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

712482

Policy instance

Insurance contract or identification number	712482
Number of Individuals Covered	493
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $200,899
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,924,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD089E3

Policy instance

Insurance contract or identification number	GLTD089E3
Number of Individuals Covered	425
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,470
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG089E3

Policy instance

Insurance contract or identification number	GLUG089E3
Number of Individuals Covered	425
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,455
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )

Policy contract number

F22862

Policy instance

Insurance contract or identification number	F22862
Number of Individuals Covered	342
Insurance policy start date	2011-01-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,859
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

836338-001

Policy instance

Insurance contract or identification number	836338-001
Number of Individuals Covered	288
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,652
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,449
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: 00000 )

Policy contract number

30026753

Policy instance

Insurance contract or identification number	30026753
Number of Individuals Covered	397
Insurance policy start date	2011-07-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,002
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

836338-000

Policy instance

Insurance contract or identification number	836338-000
Number of Individuals Covered	318
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $22,438
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

836338-001

Policy instance

Insurance contract or identification number	836338-001
Number of Individuals Covered	294
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,367
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG089E3

Policy instance

Insurance contract or identification number	GLUG089E3
Number of Individuals Covered	414
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,054
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD089E3

Policy instance

Insurance contract or identification number	GLTD089E3
Number of Individuals Covered	414
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,904
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

526973

Policy instance

Insurance contract or identification number	526973
Number of Individuals Covered	130
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $19,397
Welfare Benefit Premiums Paid to Carrier	USD $277,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

712482

Policy instance

Insurance contract or identification number	712482
Number of Individuals Covered	583
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $159,875
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,233,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL089E3

Policy instance

Insurance contract or identification number	GVTL089E3
Number of Individuals Covered	183
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,710
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )

Policy contract number

F22749

Policy instance

Insurance contract or identification number	F22749
Number of Individuals Covered	339
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $3,199
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GUIDEHOUSE MANAGED SERVICES LLC
Employer identification number (EIN):	202858838
NAIC Classification:	541600

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3949070