401k Plan data: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN plan

PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN
Plan identification number	501

PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC has sponsored the creation of one or more 401k plans.

Company Name: PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC

Employer identification number (EIN): 270943279

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2009-09-16

Company Identification Number: 602954269

Legal Registered Office Address: 300 DESCHUTES WAY SW STE 208 MC-CSC1

TUMWATER
United States of America (USA)
98501

More information about PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 CLARISSA WILLETT
501 2016-01-01 CLARISSA WILLETT
501 2015-01-01 CLARISSA WILLETT
501 2014-01-01 CLARISSA WILLETT
501 2013-01-01 CLARISSA WILLETT CLARISSA WILLETT 2014-08-29
501 2012-01-01 CLARISSA WILLETT CLARISSA WILLETT 2014-08-29
501 2011-01-01 CLARISSA WILLETT CLARISSA WILLETT 2014-08-29

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	CLARISSA WILLETT
501	2016-01-01	CLARISSA WILLETT
501	2015-01-01	CLARISSA WILLETT
501	2014-01-01	CLARISSA WILLETT
501	2013-01-01	CLARISSA WILLETT	CLARISSA WILLETT	2014-08-29
501	2012-01-01	CLARISSA WILLETT	CLARISSA WILLETT	2014-08-29
501	2011-01-01	CLARISSA WILLETT	CLARISSA WILLETT	2014-08-29

Plan Statistics for PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN

Measure Date Value
2017: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,402
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,867
Number of retired or separated participants receiving benefits 2017-01-01 10
Total of all active and inactive participants 2017-01-01 1,877
2016: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,395
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,396
Number of retired or separated participants receiving benefits 2016-01-01 6
Total of all active and inactive participants 2016-01-01 1,402
2015: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,894
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,385
Number of retired or separated participants receiving benefits 2015-01-01 10
Total of all active and inactive participants 2015-01-01 1,395
2014: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,242
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,874
Number of retired or separated participants receiving benefits 2014-01-01 20
Total of all active and inactive participants 2014-01-01 1,894
2013: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,236
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,225
Number of retired or separated participants receiving benefits 2013-01-01 17
Total of all active and inactive participants 2013-01-01 1,242
2012: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,191
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,224
Number of retired or separated participants receiving benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 1,236
2011: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,111
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,183
Number of retired or separated participants receiving benefits 2011-01-01 8
Total of all active and inactive participants 2011-01-01 1,191

Measure	Date	Value
2017: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,402
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,867
Number of retired or separated participants receiving benefits	2017-01-01	10
Total of all active and inactive participants	2017-01-01	1,877
2016: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,395
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,396
Number of retired or separated participants receiving benefits	2016-01-01	6
Total of all active and inactive participants	2016-01-01	1,402
2015: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,894
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,385
Number of retired or separated participants receiving benefits	2015-01-01	10
Total of all active and inactive participants	2015-01-01	1,395
2014: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,242
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,874
Number of retired or separated participants receiving benefits	2014-01-01	20
Total of all active and inactive participants	2014-01-01	1,894
2013: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,236
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,225
Number of retired or separated participants receiving benefits	2013-01-01	17
Total of all active and inactive participants	2013-01-01	1,242
2012: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,191
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,224
Number of retired or separated participants receiving benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	1,236
2011: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,111
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,183
Number of retired or separated participants receiving benefits	2011-01-01	8
Total of all active and inactive participants	2011-01-01	1,191

Form 5500 Responses for PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN

2017: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: PATHOLOGY ASSOICATES MEDICAL LABORATORIES, LLC HEALTH AND WELFARE PLAN 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

750985

Policy instance

Insurance contract or identification number	750985
Number of Individuals Covered	1658
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $29,143
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability 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 $18,158
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0148356

Policy instance

Insurance contract or identification number	0148356
Number of Individuals Covered	6
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $107
Total amount of fees paid to insurance company	USD $86
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107
Amount paid for insurance broker fees	86
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0148355

Policy instance

Insurance contract or identification number	0148355
Number of Individuals Covered	119
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $785
Total amount of fees paid to insurance company	USD $555
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $13,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $785
Amount paid for insurance broker fees	555
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	263
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $22,230
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,701,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,657
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	22
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,017
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,017
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,629
Total amount of fees paid to insurance company	USD $14
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $-4,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,629
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0148355

Policy instance

Insurance contract or identification number	0148355
Number of Individuals Covered	155
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $688
Total amount of fees paid to insurance company	USD $14
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $12,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $688
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0148356

Policy instance

Insurance contract or identification number	0148356
Number of Individuals Covered	3
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $111
Total amount of fees paid to insurance company	USD $14
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $111
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

750985

Policy instance

Insurance contract or identification number	750985
Number of Individuals Covered	1626
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $25,332
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability 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 $25,332
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	332
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $27,640
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,523,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,640
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	28
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,141
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,141
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	1773
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $19,323
Total amount of fees paid to insurance company	USD $11
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $637,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,323
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0148355

Policy instance

Insurance contract or identification number	0148355
Number of Individuals Covered	211
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $828
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $13,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $828
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	344
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $23,071
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,513,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,071
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

267 AND 320

Policy instance

Insurance contract or identification number	267 AND 320
Number of Individuals Covered	2564
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $25,343
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid in cash?	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 $25,343
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	1857
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $20,323
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $650,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,323
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

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

Policy contract number

267/320

Policy instance

Insurance contract or identification number	267/320
Number of Individuals Covered	3424
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $27,612
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid in cash?	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 $27,612
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	363
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $31,956
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,534,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,956
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	35
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,784
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,784
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	397
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $37,419
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,861,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,419
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC.

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	1818
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $16,965
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $468,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,965
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC.

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

Policy contract number

267/320

Policy instance

Insurance contract or identification number	267/320
Number of Individuals Covered	3427
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $27,612
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	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 $27,612
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC.

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	35
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,420
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,420
Insurance broker organization code?	3
Insurance broker name	MOLONEY & O'NEILL LIFE INC.

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	31
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,918
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	456
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $36,427
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,987,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

267/320

Policy instance

Insurance contract or identification number	267/320
Number of Individuals Covered	3409
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $27,537
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	1788
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $15,797
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTIAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $413,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0144232

Policy instance

Insurance contract or identification number	0144232
Number of Individuals Covered	1675
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,529
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $327,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

267/320

Policy instance

Insurance contract or identification number	267/320
Number of Individuals Covered	3252
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $24,206
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4974000

Policy instance

Insurance contract or identification number	4974000
Number of Individuals Covered	29
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,567
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4913400

Policy instance

Insurance contract or identification number	4913400
Number of Individuals Covered	395
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $29,995
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,499,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
Employer identification number (EIN):	270943279
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2009-09-16
Company Identification Number:	602954269
Legal Registered Office Address:	300 DESCHUTES WAY SW STE 208 MC-CSC1 TUMWATER United States of America (USA) 98501