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PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 401k Plan overview

Plan NamePRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN
Plan identification number 501

PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN Benefits

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

401k Sponsoring company profile

PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST has sponsored the creation of one or more 401k plans.

Company Name:PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Employer identification number (EIN):910666887
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 1956-09-10
Company Identification Number: 578060607
Legal Registered Office Address: 999 3RD AVE STE 4600

SEATTLE
United States of America (USA)
981044084

More information about PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-04-01KAREN BRANDT2024-10-08
5012022-04-01KAREN BRANDT2023-10-17
5012021-04-01KAREN BRANDT2022-10-31
5012020-04-01JULIE HUNTOON2021-10-13
5012019-04-01JULIE HUNTOON2020-10-14
5012018-04-01JULIE HUNTOON2019-10-25
5012017-04-01
5012016-04-01
5012015-04-01EVE JAKOBOSKI
5012015-03-01EVE JAKOBOSKI
5012014-03-01EVE JACOBOSKI
5012013-03-01LARRY DART
5012012-03-01LARRY DART
5012011-03-01LARRY DART
5012009-03-01CHARLENE ANDERSON

Plan Statistics for PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN

401k plan membership statisitcs for PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN

Measure Date Value
2023: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2023 401k membership
Total participants, beginning-of-year2023-04-01576
Total number of active participants reported on line 7a of the Form 55002023-04-01569
Number of retired or separated participants receiving benefits2023-04-012
Number of other retired or separated participants entitled to future benefits2023-04-010
Total of all active and inactive participants2023-04-01571
Number of employers contributing to the scheme2023-04-010
2022: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01591
Total number of active participants reported on line 7a of the Form 55002022-04-01569
Number of retired or separated participants receiving benefits2022-04-017
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01576
Number of employers contributing to the scheme2022-04-010
2021: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01638
Total number of active participants reported on line 7a of the Form 55002021-04-01591
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01591
Number of employers contributing to the scheme2021-04-010
2020: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01667
Total number of active participants reported on line 7a of the Form 55002020-04-01638
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01638
Number of employers contributing to the scheme2020-04-010
2019: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01211
Total number of active participants reported on line 7a of the Form 55002019-04-01217
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01217
Number of employers contributing to the scheme2019-04-010
2018: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01268
Total number of active participants reported on line 7a of the Form 55002018-04-01211
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01211
Number of employers contributing to the scheme2018-04-010
2017: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01330
Total number of active participants reported on line 7a of the Form 55002017-04-01268
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01268
2016: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01256
Total number of active participants reported on line 7a of the Form 55002016-04-01330
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01330
2015: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01284
Total number of active participants reported on line 7a of the Form 55002015-04-01330
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01330
Total participants, beginning-of-year2015-03-01290
Total number of active participants reported on line 7a of the Form 55002015-03-01284
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01284
2014: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01268
Total number of active participants reported on line 7a of the Form 55002014-03-01288
Number of retired or separated participants receiving benefits2014-03-012
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01290
2013: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01309
Total number of active participants reported on line 7a of the Form 55002013-03-01315
Number of retired or separated participants receiving benefits2013-03-011
Number of other retired or separated participants entitled to future benefits2013-03-010
Total of all active and inactive participants2013-03-01316
2012: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01245
Total number of active participants reported on line 7a of the Form 55002012-03-01215
Number of retired or separated participants receiving benefits2012-03-010
Number of other retired or separated participants entitled to future benefits2012-03-010
Total of all active and inactive participants2012-03-01215
2011: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01223
Total number of active participants reported on line 7a of the Form 55002011-03-01245
Number of retired or separated participants receiving benefits2011-03-010
Number of other retired or separated participants entitled to future benefits2011-03-010
Total of all active and inactive participants2011-03-01245
2009: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-01173
Total number of active participants reported on line 7a of the Form 55002009-03-01187
Number of retired or separated participants receiving benefits2009-03-015
Number of other retired or separated participants entitled to future benefits2009-03-010
Total of all active and inactive participants2009-03-01192

Form 5500 Responses for PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN

2023: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan funding arrangement – General assets of the sponsorYes
2023-04-01Plan benefit arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – General assets of the sponsorYes
2022: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)No
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Submission has been amendedNo
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2009: PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST GROUP INSURANCE PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberWA799
Policy instance 3
Insurance contract or identification numberWA799
Number of Individuals Covered22
Insurance policy start date2023-04-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $321
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-018231-00
Policy instance 2
Insurance contract or identification number01-018231-00
Number of Individuals Covered569
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $23,938
Total amount of fees paid to insurance companyUSD $6,835
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $129,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
Insurance contract or identification number30012882
Number of Individuals Covered14
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $715
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberWA799
Policy instance 3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number101823100
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number0101823100
Policy instance 2
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number0101823100
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906949
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number906949
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number231683
Policy instance 1
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6497800
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149/46812
Policy instance 5
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 4
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 3
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number1414700
Policy instance 1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 1
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number1414700
Policy instance 2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217300
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149/46812
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30012882
Policy instance 5
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012882
Policy instance 4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217300
Policy instance 2
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number1414700
Policy instance 1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149/46812
Policy instance 5
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number30012882
Policy instance 4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217301/1414700
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149/46812
Policy instance 3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149
Policy instance 3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 1
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217300/6226800
Policy instance 2
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217300
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149
Policy instance 3
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number5217300
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number126149
Policy instance 3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number763
Policy instance 2

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