LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN
Plan identification number	003

LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1. Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations. Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations. Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD has sponsored the creation of one or more 401k plans.

Company Name:	LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Employer identification number (EIN):	770003859
NAIC Classification:	622000
NAIC Description:	Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2022-01-01
003	2021-01-01
003	2020-01-01
003	2019-01-01
003	2018-01-01
003	2017-01-01	MARGARET PELLARIN		GREGORY SOUZA	2018-07-30
003	2016-01-01	MARGARET PELLARIN		GREGORY SOUZA	2017-10-11
003	2015-01-01	MARGARET PELLARIN		GREGORY SOUZA	2016-10-13
003	2014-01-01	MARGARET PELLARIN		GREGORY SOUZA	2015-10-13
003	2013-01-01	MARGARET PELLARIN		GREGORY SOUZA	2014-10-06
003	2012-01-01	MARGARET PELLARIN		SOUZA GREGORY	2013-10-14
003	2011-01-01	MARGARET PELLARIN		SOUZA GREGORY	2012-07-31
003	2009-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-15
003	2008-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2007-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2006-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2005-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2004-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2003-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2002-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2001-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	2000-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	1999-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	1998-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	1997-01-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06
003	1996-04-01	MARGARET PELLARIN		GREGORY SOUZA	2010-10-06

Plan Statistics for LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN

401k plan membership statisitcs for LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN

Measure	Date	Value
2022: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	71
Number of retired or separated participants receiving benefits	2022-01-01	8
Number of other retired or separated participants entitled to future benefits	2022-01-01	156
Total of all active and inactive participants	2022-01-01	235
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	235
Number of participants with account balances	2022-01-01	235
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	265
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	70
Number of retired or separated participants receiving benefits	2021-01-01	176
Total of all active and inactive participants	2021-01-01	246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	246
Number of participants with account balances	2021-01-01	246
2020: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	277
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	82
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	183
Total of all active and inactive participants	2020-01-01	265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	265
Number of participants with account balances	2020-01-01	265
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	299
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	94
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	181
Total of all active and inactive participants	2019-01-01	275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	2
Total participants	2019-01-01	277
Number of participants with account balances	2019-01-01	277
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	319
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	113
Number of other retired or separated participants entitled to future benefits	2018-01-01	185
Total of all active and inactive participants	2018-01-01	298
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	299
Number of participants with account balances	2018-01-01	299
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	337
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	128
Number of other retired or separated participants entitled to future benefits	2017-01-01	189
Total of all active and inactive participants	2017-01-01	317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	2
Total participants	2017-01-01	319
Number of participants with account balances	2017-01-01	319
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	345
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	141
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	196
Total of all active and inactive participants	2016-01-01	337
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	337
Number of participants with account balances	2016-01-01	337
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	365
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	147
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	198
Total of all active and inactive participants	2015-01-01	345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	345
Number of participants with account balances	2015-01-01	345
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	400
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	158
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	205
Total of all active and inactive participants	2014-01-01	363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	2
Total participants	2014-01-01	365
Number of participants with account balances	2014-01-01	365
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	430
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	189
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	208
Total of all active and inactive participants	2013-01-01	397
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	3
Total participants	2013-01-01	400
Number of participants with account balances	2013-01-01	400
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	443
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	210
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	218
Total of all active and inactive participants	2012-01-01	428
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	430
Number of participants with account balances	2012-01-01	430
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	468
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	223
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	218
Total of all active and inactive participants	2011-01-01	441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	2
Total participants	2011-01-01	443
Number of participants with account balances	2011-01-01	443
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	263
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	293
Total of all active and inactive participants	2009-01-01	556
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	3
Total participants	2009-01-01	559
Number of participants with account balances	2009-01-01	559
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2008: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2008 401k membership
Total of all active and inactive participants	2008-01-01	0
Total participants	2008-01-01	0
2007: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2007 401k membership
Total of all active and inactive participants	2007-01-01	0
Total participants	2007-01-01	0
2006: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2006 401k membership
Total of all active and inactive participants	2006-01-01	0
Total participants	2006-01-01	0
2005: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2005 401k membership
Total of all active and inactive participants	2005-01-01	0
Total participants	2005-01-01	0
2004: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2004 401k membership
Total of all active and inactive participants	2004-01-01	0
Total participants	2004-01-01	0
2003: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2003 401k membership
Total of all active and inactive participants	2003-01-01	0
Total participants	2003-01-01	0
2002: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2002 401k membership
Total of all active and inactive participants	2002-01-01	0
Total participants	2002-01-01	0
2001: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2001 401k membership
Total of all active and inactive participants	2001-01-01	0
Total participants	2001-01-01	0
2000: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2000 401k membership
Total of all active and inactive participants	2000-01-01	0
Total participants	2000-01-01	0
1999: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1999 401k membership
Total of all active and inactive participants	1999-01-01	0
Total participants	1999-01-01	0
1998: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1998 401k membership
Total of all active and inactive participants	1998-01-01	0
Total participants	1998-01-01	0
1997: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1997 401k membership
Total of all active and inactive participants	1997-01-01	0
Total participants	1997-01-01	0
1996: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1996 401k membership
Total of all active and inactive participants	1996-04-01	0
Total participants	1996-04-01	0

Financial Data on LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN

Measure	Date	Value
2022 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-2,224,175
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,091,054
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,084,694
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$0
Value of total assets at end of year	2022-12-31	$14,675,882
Value of total assets at beginning of year	2022-12-31	$17,991,111
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,360
Total interest from all sources	2022-12-31	$170,957
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$399,365
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$399,365
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$88,322
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$114,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-3,315,229
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$14,675,882
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$17,991,111
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$8,967,053
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$11,905,043
Value of interest in pooled separate accounts at end of year	2022-12-31	$144,134
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$133,223
Interest earned on other investments	2022-12-31	$170,957
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$5,476,373
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$5,838,845
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,805,408
Net investment gain/loss from pooled separate accounts	2022-12-31	$10,911
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,084,694
Contract administrator fees	2022-12-31	$6,360
Did the plan have assets held for investment	2022-12-31	Yes
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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MOSS ADAMS
Accountancy firm EIN	2022-12-31	910189318
2021 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$2,401,955
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$2,011,448
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$2,004,225
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$0
Value of total assets at end of year	2021-12-31	$17,991,111
Value of total assets at beginning of year	2021-12-31	$17,600,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$7,223
Total interest from all sources	2021-12-31	$58,210
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$653,285
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$653,285
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$114,000
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$390,507
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$17,991,111
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$17,600,604
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$11,905,043
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$11,792,465
Value of interest in pooled separate accounts at end of year	2021-12-31	$133,223
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$113,025
Interest earned on other investments	2021-12-31	$58,210
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$5,838,845
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$5,695,114
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,670,262
Net investment gain/loss from pooled separate accounts	2021-12-31	$20,198
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$2,004,225
Contract administrator fees	2021-12-31	$7,223
Did the plan have assets held for investment	2021-12-31	Yes
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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MOSS ADAMS
Accountancy firm EIN	2021-12-31	910189318
2020 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$2,221,379
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,612,439
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,605,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$0
Value of total assets at end of year	2020-12-31	$17,600,604
Value of total assets at beginning of year	2020-12-31	$16,991,664
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$7,315
Total interest from all sources	2020-12-31	$62,695
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$360,266
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$360,266
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$463,444
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$608,940
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$17,600,604
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$16,991,664
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$11,792,465
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$10,934,685
Value of interest in pooled separate accounts at end of year	2020-12-31	$113,025
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$113,983
Interest earned on other investments	2020-12-31	$62,695
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$5,695,114
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$5,479,552
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,799,375
Net investment gain/loss from pooled separate accounts	2020-12-31	$-957
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,605,124
Contract administrator fees	2020-12-31	$7,315
Did the plan have assets held for investment	2020-12-31	Yes
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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MOSS ADAMS
Accountancy firm EIN	2020-12-31	910189318
2019 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$2,948,743
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$2,261,781
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,253,937
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$0
Value of total assets at end of year	2019-12-31	$16,991,664
Value of total assets at beginning of year	2019-12-31	$16,304,702
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,844
Total interest from all sources	2019-12-31	$163,709
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$350,665
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$350,665
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$463,444
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$358,382
Other income not declared elsewhere	2019-12-31	$105,062
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$686,962
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$16,991,664
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$16,304,702
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$10,934,685
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$10,191,617
Value of interest in pooled separate accounts at end of year	2019-12-31	$113,983
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$108,029
Interest earned on other investments	2019-12-31	$163,709
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$5,479,552
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$5,646,674
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,323,353
Net investment gain/loss from pooled separate accounts	2019-12-31	$5,954
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$2,253,937
Contract administrator fees	2019-12-31	$7,844
Did the plan have assets held for investment	2019-12-31	Yes
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MOSS ADAMS
Accountancy firm EIN	2019-12-31	910189318
2018 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-445,789
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,645,858
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,638,061
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$16,304,702
Value of total assets at beginning of year	2018-12-31	$18,396,349
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$7,797
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$435,336
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$435,336
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$358,382
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$92,825
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-2,091,647
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$16,304,702
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$18,396,349
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$10,191,617
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$13,742,972
Value of interest in pooled separate accounts at end of year	2018-12-31	$108,029
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$11,046
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$5,646,674
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$4,642,331
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-976,047
Net investment gain/loss from pooled separate accounts	2018-12-31	$2,097
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,638,061
Contract administrator fees	2018-12-31	$7,797
Did the plan have assets held for investment	2018-12-31	Yes
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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MOSS ADAMS
Accountancy firm EIN	2018-12-31	910189318
2017 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$2,612,126
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,056,376
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,045,384
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$18,396,349
Value of total assets at beginning of year	2017-12-31	$16,840,599
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$10,992
Total interest from all sources	2017-12-31	$19
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$290,769
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$290,769
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Other income not declared elsewhere	2017-12-31	$174,223
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,555,750
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$18,396,349
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$16,840,599
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$13,742,972
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$11,679,475
Value of interest in pooled separate accounts at end of year	2017-12-31	$11,046
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$11,909
Interest on participant loans	2017-12-31	$19
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$374,325
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$374,325
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$4,642,331
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$4,774,890
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$2,147,115
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,045,384
Contract administrator fees	2017-12-31	$10,992
Did the plan have assets held for investment	2017-12-31	Yes
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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MOSS ADAMS
Accountancy firm EIN	2017-12-31	910189318
2016 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$38,704
Total income from all sources (including contributions)	2016-12-31	$1,005,273
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$524,945
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$514,956
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$16,840,599
Value of total assets at beginning of year	2016-12-31	$16,398,975
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$9,989
Total interest from all sources	2016-12-31	$580
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$309,254
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$309,254
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Assets. Other investments not covered elsewhere at end of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-12-31	$1,091,372
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$38,704
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$480,328
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$16,840,599
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$16,360,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$11,679,475
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$10,327,323
Value of interest in pooled separate accounts at end of year	2016-12-31	$11,909
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,903
Interest on participant loans	2016-12-31	$580
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$374,325
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$418,446
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$418,446
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$4,774,890
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$4,559,931
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$695,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$514,956
Contract administrator fees	2016-12-31	$9,989
Did the plan have assets held for investment	2016-12-31	Yes
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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	MOSS ADAMS
Accountancy firm EIN	2016-12-31	910189318
2015 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$38,704
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$272,184
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,196,049
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,189,457
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$16,398,975
Value of total assets at beginning of year	2015-12-31	$17,284,136
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$6,592
Total interest from all sources	2015-12-31	$-2,108
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$459,830
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$459,830
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$1,091,372
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$2,724,112
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$38,704
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-923,865
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$16,360,271
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$17,284,136
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$10,327,323
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$9,352,740
Value of interest in pooled separate accounts at end of year	2015-12-31	$1,903
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$1,760
Interest on participant loans	2015-12-31	$-2,108
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$418,446
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$419,136
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$419,136
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$4,559,931
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$4,786,388
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-185,538
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,189,457
Contract administrator fees	2015-12-31	$6,592
Did the plan have assets held for investment	2015-12-31	Yes
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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MOSS ADAMS
Accountancy firm EIN	2015-12-31	910189318
2014 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,036,339
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,321,345
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,314,035
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$17,284,136
Value of total assets at beginning of year	2014-12-31	$18,569,142
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$7,310
Total interest from all sources	2014-12-31	$704
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$563,463
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$563,463
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$2,724,112
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$3,110,272
Other income not declared elsewhere	2014-12-31	$472,172
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-1,285,006
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$17,284,136
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$18,569,142
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$9,352,740
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$10,138,349
Value of interest in pooled separate accounts at end of year	2014-12-31	$1,760
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,569
Interest on participant loans	2014-12-31	$704
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$419,136
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$518,677
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$518,677
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$4,786,388
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$4,800,275
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,314,035
Contract administrator fees	2014-12-31	$7,310
Did the plan have assets held for investment	2014-12-31	Yes
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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MOSS ADAMS
Accountancy firm EIN	2014-12-31	910189318
2013 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$3,029,541
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,351,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$2,344,171
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$18,569,142
Value of total assets at beginning of year	2013-12-31	$17,891,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$7,647
Total interest from all sources	2013-12-31	$1,270
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$537,418
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$537,418
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$3,110,272
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$3,011,478
Other income not declared elsewhere	2013-12-31	$2,490,853
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$677,723
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$18,569,142
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$17,891,419
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$10,138,349
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$9,384,053
Value of interest in pooled separate accounts at end of year	2013-12-31	$1,569
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,430
Interest on participant loans	2013-12-31	$1,270
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$518,677
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$593,991
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$593,991
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$4,800,275
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$4,900,467
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$2,344,171
Contract administrator fees	2013-12-31	$7,647
Did the plan have assets held for investment	2013-12-31	Yes
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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MOSS ADAMS
Accountancy firm EIN	2013-12-31	910189318
2012 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,786,849
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$863,511
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$855,474
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$17,891,419
Value of total assets at beginning of year	2012-12-31	$16,968,081
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$8,037
Total interest from all sources	2012-12-31	$1,379
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$315,564
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$315,564
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Participant contributions at beginning of year	2012-12-31	$232,882
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$3,011,478
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$2,781,731
Other income not declared elsewhere	2012-12-31	$1,469,906
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$923,338
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$17,891,419
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$16,968,081
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$9,384,053
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$9,010,277
Value of interest in pooled separate accounts at end of year	2012-12-31	$1,430
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,300
Interest on participant loans	2012-12-31	$1,379
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$593,991
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$365,655
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$365,655
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$4,900,467
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$4,576,236
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$855,474
Contract administrator fees	2012-12-31	$8,037
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MOSS ADAMS
Accountancy firm EIN	2012-12-31	910189318
2011 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$177,500
Total transfer of assets from this plan	2011-12-31	$1,869
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$-139,671
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,926,030
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,917,579
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$16,968,081
Value of total assets at beginning of year	2011-12-31	$18,858,151
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$8,451
Total interest from all sources	2011-12-31	$1,637
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$333,836
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$333,836
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Participant contributions at end of year	2011-12-31	$232,882
Participant contributions at beginning of year	2011-12-31	$324,886
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$2,781,731
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$3,101,781
Other income not declared elsewhere	2011-12-31	$-475,144
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-2,065,701
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$16,968,081
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$18,858,151
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$9,010,277
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$9,976,150
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,300
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$983
Interest on participant loans	2011-12-31	$1,637
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$365,655
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$391,362
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$391,362
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$4,576,236
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$5,062,989
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,917,579
Contract administrator fees	2011-12-31	$8,451
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	MOHLER, NIXON & WILLIAMS
Accountancy firm EIN	2011-12-31	770106234
2010 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$31,246
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,830,072
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$858,463
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$849,522
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$18,858,151
Value of total assets at beginning of year	2010-12-31	$17,855,296
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$8,941
Total interest from all sources	2010-12-31	$2,248
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$290,313
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$290,313
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Participant contributions at end of year	2010-12-31	$324,886
Participant contributions at beginning of year	2010-12-31	$346,531
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$3,101,781
Other income not declared elsewhere	2010-12-31	$386,920
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$971,609
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$18,858,151
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$17,855,296
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$9,976,150
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$11,991,137
Value of interest in pooled separate accounts at end of year	2010-12-31	$983
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$746
Interest on participant loans	2010-12-31	$2,248
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$391,362
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$437,985
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$437,985
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$5,062,989
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$5,078,897
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,150,591
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$849,522
Contract administrator fees	2010-12-31	$8,941
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	MOHLER, NIXON & WILLIAMS
Accountancy firm EIN	2010-12-31	770106234
2009 : LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN

2022: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Multi-employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2007: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Multi-employer plan
2007-01-01	Submission has been amended	Yes
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2006: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Multi-employer plan
2006-01-01	Submission has been amended	Yes
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2005: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Multi-employer plan
2005-01-01	Submission has been amended	Yes
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2004: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Multi-employer plan
2004-01-01	Submission has been amended	Yes
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2003: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2003 form 5500 responses
2003-01-01	Type of plan entity	Multi-employer plan
2003-01-01	Submission has been amended	Yes
2003-01-01	This submission is the final filing	No
2003-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-01-01	Plan is a collectively bargained plan	No
2002: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2002 form 5500 responses
2002-01-01	Type of plan entity	Multi-employer plan
2002-01-01	Submission has been amended	Yes
2002-01-01	This submission is the final filing	No
2002-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-01-01	Plan is a collectively bargained plan	No
2001: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2001 form 5500 responses
2001-01-01	Type of plan entity	Multi-employer plan
2001-01-01	Submission has been amended	Yes
2001-01-01	This submission is the final filing	No
2001-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-01-01	Plan is a collectively bargained plan	No
2000: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 2000 form 5500 responses
2000-01-01	Type of plan entity	Single employer plan
2000-01-01	Submission has been amended	Yes
2000-01-01	This submission is the final filing	No
2000-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2000-01-01	Plan is a collectively bargained plan	No
1999: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1999 form 5500 responses
1999-01-01	Type of plan entity	Single employer plan
1999-01-01	Submission has been amended	Yes
1999-01-01	This submission is the final filing	No
1999-01-01	This return/report is a short plan year return/report (less than 12 months)	No
1999-01-01	Plan is a collectively bargained plan	No
1998: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1998 form 5500 responses
1998-01-01	Type of plan entity	Single employer plan
1998-01-01	Submission has been amended	Yes
1998-01-01	This submission is the final filing	No
1998-01-01	This return/report is a short plan year return/report (less than 12 months)	No
1998-01-01	Plan is a collectively bargained plan	No
1997: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1997 form 5500 responses
1997-01-01	Type of plan entity	Single employer plan
1997-01-01	Submission has been amended	Yes
1997-01-01	This submission is the final filing	No
1997-01-01	This return/report is a short plan year return/report (less than 12 months)	No
1997-01-01	Plan is a collectively bargained plan	No
1996: LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD TAX-SHELTERED ANNUITY PLAN 1996 form 5500 responses
1996-04-01	Type of plan entity	Single employer plan
1996-04-01	Submission has been amended	Yes
1996-04-01	This submission is the final filing	No
1996-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
1996-04-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 002
Policy instance	3
Insurance contract or identification number 05295 002 Number of Individuals Covered 35 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $200 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $104 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 69 Insurance policy start date 2021-12-31 Insurance policy end date 2022-12-30 Total amount of commissions paid to insurance broker USD $12,891 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $12,891 Insurance broker organization code? 4
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 26 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract number	64835
Policy instance	5
Insurance contract or identification number 64835 Number of Individuals Covered 10 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 001
Policy instance	4
Insurance contract or identification number 05295 001 Number of Individuals Covered 25 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $33 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $33 Insurance broker organization code? 3
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 29 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 72 Insurance policy start date 2020-12-31 Insurance policy end date 2021-12-30 Total amount of commissions paid to insurance broker USD $12,118 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $12,118 Insurance broker organization code? 4
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 002
Policy instance	3
Insurance contract or identification number 05295 002 Number of Individuals Covered 37 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $253 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $133 Insurance broker organization code? 3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 001
Policy instance	4
Insurance contract or identification number 05295 001 Number of Individuals Covered 25 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $38 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $38 Insurance broker organization code? 3
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract number	64835
Policy instance	5
Insurance contract or identification number 64835 Number of Individuals Covered 2 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 33 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 80 Insurance policy start date 2019-12-31 Insurance policy end date 2020-12-30 Total amount of commissions paid to insurance broker USD $13,035 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $13,035 Insurance broker organization code? 4
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 002
Policy instance	3
Insurance contract or identification number 05295 002 Number of Individuals Covered 39 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $197 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $50 Insurance broker organization code? 3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295 001
Policy instance	4
Insurance contract or identification number 05295 001 Number of Individuals Covered 27 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $40 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $40 Insurance broker organization code? 3
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract number	64835
Policy instance	5
Insurance contract or identification number 64835 Number of Individuals Covered 50 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 33 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 85 Insurance policy start date 2018-12-31 Insurance policy end date 2019-12-30 Total amount of commissions paid to insurance broker USD $13,999 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $13,999 Insurance broker organization code? 4
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 40 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $210 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $69 Insurance broker organization code? 3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 27 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $55 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $55 Insurance broker organization code? 3
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract number	64835
Policy instance	5
Insurance contract or identification number 64835 Number of Individuals Covered 50 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 33 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 91 Insurance policy start date 2017-12-31 Insurance policy end date 2018-12-30 Total amount of commissions paid to insurance broker USD $15,685 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $15,685 Insurance broker organization code? 4
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 45 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $175 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $79 Insurance broker organization code? 3
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 29 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 1 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 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 Insurance broker organization code? 3
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract number	64835
Policy instance	5
Insurance contract or identification number 64835 Number of Individuals Covered 299 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 31 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $98 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $98 Insurance broker organization code? 3 Insurance broker name FITTS, KATHLEEN M
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 47 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $135 Total amount of fees paid to insurance company USD $0 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 1 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 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 Commission paid to Insurance Broker USD $67 Insurance broker organization code? 3 Insurance broker name FITTS, KATHLEEN
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 97 Insurance policy start date 2016-12-31 Insurance policy end date 2017-12-29 Total amount of commissions paid to insurance broker USD $17,700 Total amount of fees paid to insurance company USD $0 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? Yes 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 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 Commission paid to Insurance Broker USD $17,700 Insurance broker organization code? 4 Insurance broker name LINCOLN FINANCIAL ADVISORS
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 36 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 40 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 101 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $14,030 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? Yes 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 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 Commission paid to Insurance Broker USD $14,030 Insurance broker organization code? 4 Insurance broker name LINCOLN FINANCIAL ADVISORS
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 49 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $143 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 1 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 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 Commission paid to Insurance Broker USD $58 Insurance broker organization code? 3 Insurance broker name FITTS, KATHLEEN
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 33 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $68 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 1 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 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 Commission paid to Insurance Broker USD $68 Insurance broker organization code? 3 Insurance broker name FITTS, KATHLEEN M
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 108 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $14,324 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? Yes 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 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 Commission paid to Insurance Broker USD $14,324 Insurance broker organization code? 4 Insurance broker name LINCOLN FINANCIAL ADVISORS
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 35 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $144 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 1 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 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 Commission paid to Insurance Broker USD $131 Insurance broker organization code? 3 Insurance broker name CREECH, JOHN D
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 50 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $408 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 1 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 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 Commission paid to Insurance Broker USD $108 Insurance broker organization code? 3 Insurance broker name SCHULTZ, MICHAEL J
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 43 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 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? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 48 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 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? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 38 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $129 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 1 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 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 Commission paid to Insurance Broker USD $118 Insurance broker organization code? 3 Insurance broker name CREECH, JOHN D
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 52 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $374 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 1 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 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 Commission paid to Insurance Broker USD $104 Insurance broker organization code? 3 Insurance broker name FREEMAN, CARNELL A
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 120 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $13,365 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? Yes 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 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 Commission paid to Insurance Broker USD $13,365 Insurance broker organization code? 4 Insurance broker name LINCOLN FINANCIAL ADVISORS
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 58 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $353 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 1 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 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 Commission paid to Insurance Broker USD $87 Insurance broker organization code? 3 Insurance broker name FREEMAN, CARNELL A
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 40 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $146 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 1 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 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 Commission paid to Insurance Broker USD $106 Insurance broker organization code? 3 Insurance broker name CREECH, JOHN D
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 126 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $13,126 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? Yes 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 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 Commission paid to Insurance Broker USD $13,126 Insurance broker organization code? 4 Insurance broker name LINCOLN FINANCIAL ADVISORS
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	1
Insurance contract or identification number 101069 Number of Individuals Covered 56 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 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? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 42 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $1,448 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 1 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	3
Insurance contract or identification number 101069 Number of Individuals Covered 58 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 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? Yes 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	2
Insurance contract or identification number CR02705 Number of Individuals Covered 131 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $12,304 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? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	1
Insurance contract or identification number 05295 Number of Individuals Covered 59 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $598 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 1 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 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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	CR02705
Policy instance	1
Insurance contract or identification number CR02705 Number of Individuals Covered 138 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $14,034 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? Yes 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 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	101069
Policy instance	2
Insurance contract or identification number 101069 Number of Individuals Covered 60 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 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? Yes 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	3
Insurance contract or identification number 05295 Number of Individuals Covered 62 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $707 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 1 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 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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number	05295
Policy instance	4
Insurance contract or identification number 05295 Number of Individuals Covered 46 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $1,628 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 1 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 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