401k Plan data: FENCEWORKS, INC. plan

FENCEWORKS, INC. 401k Plan overview

Plan Name	FENCEWORKS, INC.
Plan identification number	501

FENCEWORKS, INC. Benefits

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

401k Sponsoring company profile

FENCEWORKS, INC. has sponsored the creation of one or more 401k plans.

Company Name: FENCEWORKS, INC.

Employer identification number (EIN): 330835270

NAIC Classification: 238900

Additional information about FENCEWORKS, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1995-02-09

Company Identification Number: 601604619

Legal Registered Office Address: 10425 NE 185TH

BOTHELL
United States of America (USA)
98011

More information about FENCEWORKS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FENCEWORKS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 GARY HANSEN 2023-09-13
501 2020-12-01 GARY HANSEN 2022-09-14
501 2019-12-01 GARY HANSEN 2021-09-15
501 2018-12-01 GARY HANSEN 2020-09-15
501 2017-12-01
501 2016-12-01 RENE TAVARES
501 2015-12-01 RENE TAVARES
501 2014-12-01 RENE TAVARES
501 2013-12-01 RENE TAVARES
501 2012-12-01 NICK NIXON
501 2011-12-01 NICK NIXON
501 2009-12-01 NICK NIXON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2021-12-01	GARY HANSEN	2023-09-13
501	2020-12-01	GARY HANSEN	2022-09-14
501	2019-12-01	GARY HANSEN	2021-09-15
501	2018-12-01	GARY HANSEN	2020-09-15
501	2017-12-01
501	2016-12-01	RENE TAVARES
501	2015-12-01	RENE TAVARES
501	2014-12-01	RENE TAVARES
501	2013-12-01	RENE TAVARES
501	2012-12-01	NICK NIXON
501	2011-12-01	NICK NIXON
501	2009-12-01	NICK NIXON

Plan Statistics for FENCEWORKS, INC.

401k plan membership statisitcs for FENCEWORKS, INC.

Measure Date Value
2021: FENCEWORKS, INC. 2021 401k membership
Total participants, beginning-of-year 2021-12-01 435
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 488
Total of all active and inactive participants 2021-12-01 488
2020: FENCEWORKS, INC. 2020 401k membership
Total participants, beginning-of-year 2020-12-01 663
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 435
Total of all active and inactive participants 2020-12-01 435
2019: FENCEWORKS, INC. 2019 401k membership
Total participants, beginning-of-year 2019-12-01 655
Total number of active participants reported on line 7a of the Form 5500 2019-12-01 663
Total of all active and inactive participants 2019-12-01 663
2018: FENCEWORKS, INC. 2018 401k membership
Total participants, beginning-of-year 2018-12-01 475
Total number of active participants reported on line 7a of the Form 5500 2018-12-01 655
Total of all active and inactive participants 2018-12-01 655
2017: FENCEWORKS, INC. 2017 401k membership
Total participants, beginning-of-year 2017-12-01 646
Total number of active participants reported on line 7a of the Form 5500 2017-12-01 475
Total of all active and inactive participants 2017-12-01 475
Total participants 2017-12-01 475
2016: FENCEWORKS, INC. 2016 401k membership
Total participants, beginning-of-year 2016-12-01 635
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 646
Total of all active and inactive participants 2016-12-01 646
Total participants 2016-12-01 646
2015: FENCEWORKS, INC. 2015 401k membership
Total participants, beginning-of-year 2015-12-01 611
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 635
Total of all active and inactive participants 2015-12-01 635
Total participants 2015-12-01 0
2014: FENCEWORKS, INC. 2014 401k membership
Total participants, beginning-of-year 2014-12-01 424
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 611
Total of all active and inactive participants 2014-12-01 611
Total participants 2014-12-01 0
2013: FENCEWORKS, INC. 2013 401k membership
Total participants, beginning-of-year 2013-12-01 424
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 478
Total of all active and inactive participants 2013-12-01 478
Total participants 2013-12-01 0
2012: FENCEWORKS, INC. 2012 401k membership
Total participants, beginning-of-year 2012-12-01 451
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 424
Total of all active and inactive participants 2012-12-01 424
Total participants 2012-12-01 0
2011: FENCEWORKS, INC. 2011 401k membership
Total participants, beginning-of-year 2011-12-01 721
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 451
Total of all active and inactive participants 2011-12-01 451
Total participants 2011-12-01 451
2009: FENCEWORKS, INC. 2009 401k membership
Total participants, beginning-of-year 2009-12-01 672
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 727
Total of all active and inactive participants 2009-12-01 727
Total participants 2009-12-01 727

Measure	Date	Value
2021: FENCEWORKS, INC. 2021 401k membership
Total participants, beginning-of-year	2021-12-01	435
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	488
Total of all active and inactive participants	2021-12-01	488
2020: FENCEWORKS, INC. 2020 401k membership
Total participants, beginning-of-year	2020-12-01	663
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	435
Total of all active and inactive participants	2020-12-01	435
2019: FENCEWORKS, INC. 2019 401k membership
Total participants, beginning-of-year	2019-12-01	655
Total number of active participants reported on line 7a of the Form 5500	2019-12-01	663
Total of all active and inactive participants	2019-12-01	663
2018: FENCEWORKS, INC. 2018 401k membership
Total participants, beginning-of-year	2018-12-01	475
Total number of active participants reported on line 7a of the Form 5500	2018-12-01	655
Total of all active and inactive participants	2018-12-01	655
2017: FENCEWORKS, INC. 2017 401k membership
Total participants, beginning-of-year	2017-12-01	646
Total number of active participants reported on line 7a of the Form 5500	2017-12-01	475
Total of all active and inactive participants	2017-12-01	475
Total participants	2017-12-01	475
2016: FENCEWORKS, INC. 2016 401k membership
Total participants, beginning-of-year	2016-12-01	635
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	646
Total of all active and inactive participants	2016-12-01	646
Total participants	2016-12-01	646
2015: FENCEWORKS, INC. 2015 401k membership
Total participants, beginning-of-year	2015-12-01	611
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	635
Total of all active and inactive participants	2015-12-01	635
Total participants	2015-12-01	0
2014: FENCEWORKS, INC. 2014 401k membership
Total participants, beginning-of-year	2014-12-01	424
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	611
Total of all active and inactive participants	2014-12-01	611
Total participants	2014-12-01	0
2013: FENCEWORKS, INC. 2013 401k membership
Total participants, beginning-of-year	2013-12-01	424
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	478
Total of all active and inactive participants	2013-12-01	478
Total participants	2013-12-01	0
2012: FENCEWORKS, INC. 2012 401k membership
Total participants, beginning-of-year	2012-12-01	451
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	424
Total of all active and inactive participants	2012-12-01	424
Total participants	2012-12-01	0
2011: FENCEWORKS, INC. 2011 401k membership
Total participants, beginning-of-year	2011-12-01	721
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	451
Total of all active and inactive participants	2011-12-01	451
Total participants	2011-12-01	451
2009: FENCEWORKS, INC. 2009 401k membership
Total participants, beginning-of-year	2009-12-01	672
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	727
Total of all active and inactive participants	2009-12-01	727
Total participants	2009-12-01	727

Form 5500 Responses for FENCEWORKS, INC.

2021: FENCEWORKS, INC. 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2020: FENCEWORKS, INC. 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes
2019: FENCEWORKS, INC. 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes
2018: FENCEWORKS, INC. 2018 form 5500 responses
2018-12-01	Type of plan entity	Single employer plan
2018-12-01	Plan funding arrangement – Insurance	Yes
2018-12-01	Plan benefit arrangement – Insurance	Yes
2017: FENCEWORKS, INC. 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Submission has been amended	No
2017-12-01	This submission is the final filing	No
2017-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-12-01	Plan is a collectively bargained plan	No
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2016: FENCEWORKS, INC. 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2015: FENCEWORKS, INC. 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2014: FENCEWORKS, INC. 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes
2013: FENCEWORKS, INC. 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2012: FENCEWORKS, INC. 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2011: FENCEWORKS, INC. 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2009: FENCEWORKS, INC. 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GLLV0AJJR

Policy instance

Insurance contract or identification number	GLLV0AJJR
Number of Individuals Covered	129
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $1,216
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,216
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

605499

Policy instance

Insurance contract or identification number	605499
Number of Individuals Covered	145
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $21,040
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,098,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,040
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	471
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $58,678
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,668,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,678
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GUDB0AJJR

Policy instance

Insurance contract or identification number	GUDB0AJJR
Number of Individuals Covered	228
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $4,414
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,414
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	13
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $419
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $419
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	488
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $3,111
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,111
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Number of Individuals Covered	255
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $8,724
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,724
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	211
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $20,278
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,278
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

605499

Policy instance

Insurance contract or identification number	605499
Number of Individuals Covered	87
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $22,904
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $922,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,904
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	235
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $59,511
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,604,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,511
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GUDB0AJJR

Policy instance

Insurance contract or identification number	GUDB0AJJR
Number of Individuals Covered	209
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $4,383
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $154,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,383
Insurance broker organization code?	3

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	12
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $426
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $426
Insurance broker organization code?	3

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	435
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $3,089
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,089
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Number of Individuals Covered	241
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $8,742
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,742
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	200
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $18,750
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $144,231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,750
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

605499

Policy instance

Insurance contract or identification number	605499
Number of Individuals Covered	178
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $22,521
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $977,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	485
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $60,046
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,483,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GUDB0AJJR

Policy instance

Insurance contract or identification number	GUDB0AJJR
Number of Individuals Covered	201
Insurance policy start date	2019-12-01
Insurance policy end date	2020-12-01
Total amount of commissions paid to insurance broker	USD $4,456
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $158,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	458
Insurance policy start date	2019-06-01
Insurance policy end date	2020-06-01
Total amount of commissions paid to insurance broker	USD $3,195
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	14
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $478
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GUC 0AJJR

Policy instance

Insurance contract or identification number	GUC 0AJJR
Number of Individuals Covered	251
Insurance policy start date	2019-06-01
Insurance policy end date	2020-06-01
Total amount of commissions paid to insurance broker	USD $8,965
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	209
Insurance policy start date	2019-06-01
Insurance policy end date	2020-06-01
Total amount of commissions paid to insurance broker	USD $18,076
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	14
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $514
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $514
Insurance broker organization code?	3

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

Policy contract number

GUDB0AJJR

Policy instance

Insurance contract or identification number	GUDB0AJJR
Number of Individuals Covered	213
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $4,512
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $162,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,512
Insurance broker organization code?	3

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	483
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $54,135
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,167,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,135
Insurance broker organization code?	3

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

Policy contract number

605499

Policy instance

Insurance contract or identification number	605499
Number of Individuals Covered	172
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $20,970
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $839,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,970
Insurance broker organization code?	3

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	14
Insurance policy start date	2017-06-01
Insurance policy end date	2018-06-01
Total amount of commissions paid to insurance broker	USD $514
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $5,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

605499

Policy instance

Insurance contract or identification number	605499
Number of Individuals Covered	184
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $19,462
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $779,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GUDB0AJJR

Policy instance

Insurance contract or identification number	GUDB0AJJR
Number of Individuals Covered	220
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-01
Total amount of commissions paid to insurance broker	USD $4,527
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $162,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	475
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-30
Total amount of commissions paid to insurance broker	USD $46,537
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,862,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	366
Insurance policy start date	2014-08-01
Insurance policy end date	2015-08-01
Total amount of commissions paid to insurance broker	USD $2,776
Total amount of fees paid to insurance company	USD $614
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,776
Amount paid for insurance broker fees	614
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	611
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $54,627
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,194,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,627
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	174
Insurance policy start date	2014-08-01
Insurance policy end date	2015-08-01
Total amount of commissions paid to insurance broker	USD $11,800
Total amount of fees paid to insurance company	USD $1,464
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,086
Amount paid for insurance broker fees	1464
Insurance broker organization code?	3
Insurance broker name	THOMAS EDWARD BRADBURY

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	15
Insurance policy start date	2014-06-01
Insurance policy end date	2015-06-01
Total amount of commissions paid to insurance broker	USD $356
Total amount of fees paid to insurance company	USD $76
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $356
Amount paid for insurance broker fees	76
Insurance broker organization code?	3
Insurance broker name	ARK INSURANCE SERVICES, INC.

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Number of Individuals Covered	205
Insurance policy start date	2014-08-01
Insurance policy end date	2015-08-01
Total amount of commissions paid to insurance broker	USD $7,173
Total amount of fees paid to insurance company	USD $1,007
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,173
Amount paid for insurance broker fees	1007
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES INC.

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	174
Insurance policy start date	2013-08-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $11,774
Total amount of fees paid to insurance company	USD $1,142
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,066
Insurance broker organization code?	3
Amount paid for insurance broker fees	1142
Insurance broker name	THOMAS EDWARD BRADBURY

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	478
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $42,188
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,686,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,188
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	342
Insurance policy start date	2013-08-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $2,755
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,755
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Number of Individuals Covered	205
Insurance policy start date	2013-08-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $6,891
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,891
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES INC.

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

Policy contract number

GLTD0AJJR

Policy instance

Insurance contract or identification number	GLTD0AJJR
Number of Individuals Covered	117
Insurance policy start date	2013-06-01
Insurance policy end date	2014-06-01
Total amount of commissions paid to insurance broker	USD $333
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $333
Insurance broker organization code?	3
Insurance broker name	ARK INSURANCE SERVICES, INC.

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Insurance policy start date	2012-08-01
Insurance policy end date	2013-08-01
Total amount of commissions paid to insurance broker	USD $6,540
Welfare Benefit Premiums Paid to Carrier	USD $43,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,540
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES INC.

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	424
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-01
Total amount of commissions paid to insurance broker	USD $38,600
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,543,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,600
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	204
Insurance policy start date	2012-08-01
Insurance policy end date	2013-08-01
Total amount of commissions paid to insurance broker	USD $13,614
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,131
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Insurance policy start date	2012-08-01
Insurance policy end date	2013-08-01
Total amount of commissions paid to insurance broker	USD $2,780
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,780
Insurance broker organization code?	3
Insurance broker name	THE ARK INSURANCE SERVICES, INC.

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

Policy contract number

227387

Policy instance

Insurance contract or identification number	227387
Number of Individuals Covered	451
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $49,797
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,979,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GVTL0AJJR

Policy instance

Insurance contract or identification number	GVTL0AJJR
Number of Individuals Covered	297
Insurance policy start date	2011-08-01
Insurance policy end date	2012-08-01
Total amount of commissions paid to insurance broker	USD $12,644
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG0AJJR

Policy instance

Insurance contract or identification number	GLUG0AJJR
Number of Individuals Covered	366
Insurance policy start date	2011-08-01
Insurance policy end date	2012-08-01
Total amount of commissions paid to insurance broker	USD $3,703
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GUC0AJJR

Policy instance

Insurance contract or identification number	GUC0AJJR
Number of Individuals Covered	254
Insurance policy start date	2011-08-01
Insurance policy end date	2012-08-01
Total amount of commissions paid to insurance broker	USD $5,537
Welfare Benefit Premiums Paid to Carrier	USD $34,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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FENCEWORKS, INC. 401(K) SALARY REDUCTION PLAN AND TRUST [EIN = 363745137]

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Company Name:	FENCEWORKS, INC.
Employer identification number (EIN):	330835270
NAIC Classification:	238900

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1995-02-09
Company Identification Number:	601604619
Legal Registered Office Address:	10425 NE 185TH BOTHELL United States of America (USA) 98011