TRUSTEE - PACIFIC HEALTH TRUST has sponsored the creation of one or more 401k plans.
Measure | Date | Value |
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2015 : PACIFIC HEALTH TRUST 2015 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2015-05-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $81,459 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $20,499 |
Total income from all sources (including contributions) | 2015-05-31 | $2,338,179 |
Total loss/gain on sale of assets | 2015-05-31 | $0 |
Total of all expenses incurred | 2015-05-31 | $2,411,813 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $2,185,476 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $2,338,179 |
Value of total assets at end of year | 2015-05-31 | $81,459 |
Value of total assets at beginning of year | 2015-05-31 | $94,133 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $226,337 |
Total interest from all sources | 2015-05-31 | $0 |
Total dividends received (eg from common stock, registered investment company shares) | 2015-05-31 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
Administrative expenses professional fees incurred | 2015-05-31 | $154,053 |
Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
Value of fidelity bond cover | 2015-05-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
Contributions received from participants | 2015-05-31 | $17,091 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-05-31 | $0 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $5,614 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-05-31 | $61,507 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-05-31 | $20,499 |
Administrative expenses (other) incurred | 2015-05-31 | $22,001 |
Total non interest bearing cash at end of year | 2015-05-31 | $79,981 |
Total non interest bearing cash at beginning of year | 2015-05-31 | $88,519 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
Value of net income/loss | 2015-05-31 | $-73,634 |
Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $0 |
Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $73,634 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
Investment advisory and management fees | 2015-05-31 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $2,185,476 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
Contributions received in cash from employer | 2015-05-31 | $2,321,088 |
Employer contributions (assets) at end of year | 2015-05-31 | $1,478 |
Employer contributions (assets) at beginning of year | 2015-05-31 | $0 |
Contract administrator fees | 2015-05-31 | $50,283 |
Liabilities. Value of benefit claims payable at end of year | 2015-05-31 | $19,952 |
Liabilities. Value of benefit claims payable at beginning of year | 2015-05-31 | $0 |
Did the plan have assets held for investment | 2015-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
Accountancy firm name | 2015-05-31 | CLIFTONLARSONALLEN LLP |
Accountancy firm EIN | 2015-05-31 | 410746749 |
2014 : PACIFIC HEALTH TRUST 2014 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2014-05-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $20,499 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $10,015 |
Total income from all sources (including contributions) | 2014-05-31 | $6,027,320 |
Total loss/gain on sale of assets | 2014-05-31 | $0 |
Total of all expenses incurred | 2014-05-31 | $6,030,248 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $5,521,549 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $6,027,320 |
Value of total assets at end of year | 2014-05-31 | $94,133 |
Value of total assets at beginning of year | 2014-05-31 | $86,577 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $508,699 |
Total interest from all sources | 2014-05-31 | $0 |
Total dividends received (eg from common stock, registered investment company shares) | 2014-05-31 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
Administrative expenses professional fees incurred | 2014-05-31 | $432,237 |
Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
Value of fidelity bond cover | 2014-05-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
Contributions received from participants | 2014-05-31 | $28,765 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $5,614 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-05-31 | $2,734 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-05-31 | $20,499 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-05-31 | $1,235 |
Administrative expenses (other) incurred | 2014-05-31 | $4,333 |
Total non interest bearing cash at end of year | 2014-05-31 | $88,519 |
Total non interest bearing cash at beginning of year | 2014-05-31 | $78,556 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
Value of net income/loss | 2014-05-31 | $-2,928 |
Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $73,634 |
Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $76,562 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $5,521,549 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
Contributions received in cash from employer | 2014-05-31 | $5,998,555 |
Employer contributions (assets) at end of year | 2014-05-31 | $0 |
Employer contributions (assets) at beginning of year | 2014-05-31 | $5,287 |
Contract administrator fees | 2014-05-31 | $72,129 |
Liabilities. Value of benefit claims payable at end of year | 2014-05-31 | $0 |
Liabilities. Value of benefit claims payable at beginning of year | 2014-05-31 | $8,780 |
Did the plan have assets held for investment | 2014-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
Accountancy firm name | 2014-05-31 | CLIFTONLARSONALLEN LLP |
Accountancy firm EIN | 2014-05-31 | 410746749 |
2013 : PACIFIC HEALTH TRUST 2013 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2013-05-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $10,015 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $13,789 |
Total income from all sources (including contributions) | 2013-05-31 | $6,032,319 |
Total loss/gain on sale of assets | 2013-05-31 | $0 |
Total of all expenses incurred | 2013-05-31 | $5,992,738 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $5,504,874 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $6,032,319 |
Value of total assets at end of year | 2013-05-31 | $86,577 |
Value of total assets at beginning of year | 2013-05-31 | $50,770 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $487,864 |
Total interest from all sources | 2013-05-31 | $0 |
Total dividends received (eg from common stock, registered investment company shares) | 2013-05-31 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
Administrative expenses professional fees incurred | 2013-05-31 | $411,625 |
Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
Value of fidelity bond cover | 2013-05-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
Contributions received from participants | 2013-05-31 | $19,854 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-05-31 | $2,734 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-05-31 | $7,690 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-05-31 | $1,235 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-05-31 | $3,217 |
Administrative expenses (other) incurred | 2013-05-31 | $4,422 |
Total non interest bearing cash at end of year | 2013-05-31 | $78,556 |
Total non interest bearing cash at beginning of year | 2013-05-31 | $37,554 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
Value of net income/loss | 2013-05-31 | $39,581 |
Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $76,562 |
Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $36,981 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $5,504,874 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
Contributions received in cash from employer | 2013-05-31 | $6,012,465 |
Employer contributions (assets) at end of year | 2013-05-31 | $5,287 |
Employer contributions (assets) at beginning of year | 2013-05-31 | $5,526 |
Contract administrator fees | 2013-05-31 | $71,817 |
Liabilities. Value of benefit claims payable at end of year | 2013-05-31 | $8,780 |
Liabilities. Value of benefit claims payable at beginning of year | 2013-05-31 | $10,572 |
Did the plan have assets held for investment | 2013-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
Accountancy firm name | 2013-05-31 | CLIFTONLARSONALLEN LLP |
Accountancy firm EIN | 2013-05-31 | 410746749 |
2012 : PACIFIC HEALTH TRUST 2012 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2012-05-31 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $13,789 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $21,562 |
Total income from all sources (including contributions) | 2012-05-31 | $3,266,530 |
Total loss/gain on sale of assets | 2012-05-31 | $0 |
Total of all expenses incurred | 2012-05-31 | $3,257,014 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $2,984,138 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $3,266,530 |
Value of total assets at end of year | 2012-05-31 | $50,770 |
Value of total assets at beginning of year | 2012-05-31 | $49,027 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $272,876 |
Total interest from all sources | 2012-05-31 | $0 |
Total dividends received (eg from common stock, registered investment company shares) | 2012-05-31 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
Administrative expenses professional fees incurred | 2012-05-31 | $225,957 |
Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
Value of fidelity bond cover | 2012-05-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
Contributions received from participants | 2012-05-31 | $10,258 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-05-31 | $7,690 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-05-31 | $14,874 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-05-31 | $3,217 |
Administrative expenses (other) incurred | 2012-05-31 | $7,408 |
Liabilities. Value of operating payables at beginning of year | 2012-05-31 | $12,166 |
Total non interest bearing cash at end of year | 2012-05-31 | $37,554 |
Total non interest bearing cash at beginning of year | 2012-05-31 | $34,153 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
Value of net income/loss | 2012-05-31 | $9,516 |
Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $36,981 |
Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $27,465 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $2,984,138 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
Contributions received in cash from employer | 2012-05-31 | $3,256,272 |
Employer contributions (assets) at end of year | 2012-05-31 | $5,526 |
Contract administrator fees | 2012-05-31 | $39,511 |
Liabilities. Value of benefit claims payable at end of year | 2012-05-31 | $10,572 |
Liabilities. Value of benefit claims payable at beginning of year | 2012-05-31 | $9,396 |
Did the plan have assets held for investment | 2012-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
Accountancy firm name | 2012-05-31 | CLIFTONLARSONALLEN LLP |
Accountancy firm EIN | 2012-05-31 | 410746749 |
2011 : PACIFIC HEALTH TRUST 2011 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $21,562 |
Total income from all sources (including contributions) | 2011-05-31 | $2,273,761 |
Total of all expenses incurred | 2011-05-31 | $2,279,684 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $2,082,345 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $2,273,761 |
Value of total assets at end of year | 2011-05-31 | $49,027 |
Value of total assets at beginning of year | 2011-05-31 | $33,388 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $197,339 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
Administrative expenses professional fees incurred | 2011-05-31 | $127,643 |
Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
Value of fidelity bond cover | 2011-05-31 | $1,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
Contributions received from participants | 2011-05-31 | $16,447 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-05-31 | $14,874 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-05-31 | $1,843 |
Administrative expenses (other) incurred | 2011-05-31 | $2,604 |
Liabilities. Value of operating payables at end of year | 2011-05-31 | $18,139 |
Total non interest bearing cash at end of year | 2011-05-31 | $34,153 |
Total non interest bearing cash at beginning of year | 2011-05-31 | $31,545 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
Value of net income/loss | 2011-05-31 | $-5,923 |
Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $27,465 |
Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $33,388 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2011-05-31 | $0 |
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-05-31 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $2,082,345 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
Contributions received in cash from employer | 2011-05-31 | $2,257,314 |
Contract administrator fees | 2011-05-31 | $67,092 |
Liabilities. Value of benefit claims payable at end of year | 2011-05-31 | $3,423 |
Did the plan have assets held for investment | 2011-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
Accountancy firm name | 2011-05-31 | CLIFTONLARSONALLEN LLP |
Accountancy firm EIN | 2011-05-31 | 410746749 |
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 30677 |
Policy instance | 2 |
Insurance contract or identification number | 30677 | Number of Individuals Covered | 605 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-05-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $5,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 120-121-122-123 |
Policy instance | 1 |
Insurance contract or identification number | 120-121-122-123 | Number of Individuals Covered | 51 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-04-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 |
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HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | PHTW |
Policy instance | 3 |
Insurance contract or identification number | PHTW | Number of Individuals Covered | 0 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $0 | Insurance broker name | WILLIS OF OREGON |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 30677 |
Policy instance | 4 |
Insurance contract or identification number | 30677 | Number of Individuals Covered | 605 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $42,562 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 120-121-122-123 |
Policy instance | 5 |
Insurance contract or identification number | 120-121-122-123 | Number of Individuals Covered | 198 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 |
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LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 ) |
Policy contract number | WA-101733 |
Policy instance | 6 |
Insurance contract or identification number | WA-101733 | Number of Individuals Covered | 0 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 | 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? | Yes |
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HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | PHTW |
Policy instance | 1 |
Insurance contract or identification number | PHTW | Number of Individuals Covered | 920 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $3,366 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,370,953 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 3366 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF OREGON INC |
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LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 ) |
Policy contract number | WA-101733 |
Policy instance | 2 |
Insurance contract or identification number | WA-101733 | Number of Individuals Covered | 847 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $23,054 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 120-121-122-123 |
Policy instance | 3 |
Insurance contract or identification number | 120-121-122-123 | Number of Individuals Covered | 195 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 30677 |
Policy instance | 4 |
Insurance contract or identification number | 30677 | Number of Individuals Covered | 611 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $41,351 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | PHTW |
Policy instance | 1 |
Insurance contract or identification number | PHTW | Number of Individuals Covered | 909 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,876 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,278,761 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1876 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF OREGON INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12169901-0008 |
Policy instance | 6 |
Insurance contract or identification number | 12169901-0008 | Number of Individuals Covered | 286 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-13 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $6,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 120-121-122-123 |
Policy instance | 4 |
Insurance contract or identification number | 120-121-122-123 | Number of Individuals Covered | 191 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-05-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 30677 |
Policy instance | 5 |
Insurance contract or identification number | 30677 | Number of Individuals Covered | 627 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-05-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $33,660 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 ) |
Policy contract number | WA-101733 |
Policy instance | 3 |
Insurance contract or identification number | WA-101733 | Number of Individuals Covered | 752 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $22,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | G 00-435492 |
Policy instance | 2 |
Insurance contract or identification number | G 00-435492 | Number of Individuals Covered | 0 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $435 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 | Welfare Benefit Premiums Paid to Carrier | USD $23,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 435 | Additional information about fees paid to insurance broker | BROKER | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF OREGON INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | G 00-435492 |
Policy instance | 3 |
Insurance contract or identification number | G 00-435492 | Number of Individuals Covered | 166 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 | Welfare Benefit Premiums Paid to Carrier | USD $63,330 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | PHTW |
Policy instance | 2 |
Insurance contract or identification number | PHTW | Number of Individuals Covered | 804 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,960,023 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12169901 |
Policy instance | 1 |
Insurance contract or identification number | 12169901 | Number of Individuals Covered | 282 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $9,382 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 ) |
Policy contract number | WA-101733 |
Policy instance | 4 |
Insurance contract or identification number | WA-101733 | Number of Individuals Covered | 699 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $12,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 ) |
Policy contract number | WA-101733 |
Policy instance | 3 |
Insurance contract or identification number | WA-101733 | Number of Individuals Covered | 181 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $6,726 | 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: 39616 ) |
Policy contract number | 12169901 |
Policy instance | 1 |
Insurance contract or identification number | 12169901 | Number of Individuals Covered | 61 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | 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 $7,602 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | PHTW |
Policy instance | 2 |
Insurance contract or identification number | PHTW | Number of Individuals Covered | 250 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,236,131 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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