401k Plan data: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN plan

ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	501

ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

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

Company Name: ASKO PROCESSING, INC.

Employer identification number (EIN): 910823269

NAIC Classification: 332900

Additional information about ASKO PROCESSING, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1967-07-19

Company Identification Number: 578080996

Legal Registered Office Address: 434 N 35TH ST

SEATTLE
United States of America (USA)
981038607

More information about ASKO PROCESSING, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 DAVID KELLY DAVID KELLY 2019-04-26
501 2017-01-01 DAVID KELLY DAVID KELLY 2018-05-22
501 2016-01-01 DAVID KELLY DAVID KELLY 2017-03-22
501 2015-01-01 DAVID KELLY DAVID KELLY 2017-02-17
501 2014-01-01 DAVID KELLY DAVID KELLY 2017-02-08
501 2013-01-01 DAVID KELLY DAVID KELLY 2017-02-08
501 2012-01-01 DAVID KELLY DAVID KELLY 2017-02-18
501 2011-01-01 BARBARA MCCURDY
501 2009-01-01 DAVID G KELLY
501 2009-01-01 DAVID KELLY DAVID KELLY 2010-07-12

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01	DAVID KELLY	DAVID KELLY	2019-04-26
501	2017-01-01	DAVID KELLY	DAVID KELLY	2018-05-22
501	2016-01-01	DAVID KELLY	DAVID KELLY	2017-03-22
501	2015-01-01	DAVID KELLY	DAVID KELLY	2017-02-17
501	2014-01-01	DAVID KELLY	DAVID KELLY	2017-02-08
501	2013-01-01	DAVID KELLY	DAVID KELLY	2017-02-08
501	2012-01-01	DAVID KELLY	DAVID KELLY	2017-02-18
501	2011-01-01	BARBARA MCCURDY
501	2009-01-01	DAVID G KELLY
501	2009-01-01	DAVID KELLY	DAVID KELLY	2010-07-12

Plan Statistics for ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 183
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 183
2021: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 163
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 163
2020: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 185
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 0
Total of all active and inactive participants 2020-01-01 185
2019: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 228
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 0
Total of all active and inactive participants 2019-01-01 228
2018: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 209
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 209
2017: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 213
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 213
2016: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 207
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 0
Total of all active and inactive participants 2016-01-01 207
2015: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 203
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 0
Total of all active and inactive participants 2015-01-01 203
2014: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 201
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 0
Total of all active and inactive participants 2014-01-01 201
2013: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 194
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 208
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 0
Total of all active and inactive participants 2013-01-01 208
2012: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 194
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 0
Total of all active and inactive participants 2012-01-01 194
2011: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 175
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 0
Total of all active and inactive participants 2011-01-01 175
Total participants 2011-01-01 175
2009: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 174
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 0
Total of all active and inactive participants 2009-01-01 174

Measure	Date	Value
2022: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	183
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	183
2021: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	163
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	163
2020: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	185
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	0
Total of all active and inactive participants	2020-01-01	185
2019: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	228
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	0
Total of all active and inactive participants	2019-01-01	228
2018: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	209
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	209
2017: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	213
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	213
2016: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	207
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	0
Total of all active and inactive participants	2016-01-01	207
2015: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	203
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	0
Total of all active and inactive participants	2015-01-01	203
2014: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	201
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	0
Total of all active and inactive participants	2014-01-01	201
2013: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	194
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	208
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	0
Total of all active and inactive participants	2013-01-01	208
2012: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	194
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	0
Total of all active and inactive participants	2012-01-01	194
2011: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	175
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	0
Total of all active and inactive participants	2011-01-01	175
Total participants	2011-01-01	175
2009: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	174
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	0
Total of all active and inactive participants	2009-01-01	174

Form 5500 Responses for ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN

2022: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes
2009: ASKO PROCESSING, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197360002

Policy instance

Insurance contract or identification number	2197360002
Number of Individuals Covered	8
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $841
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $841
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	122
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $24,331
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,219,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,331
Insurance broker organization code?	3

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	50
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $10,152
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $505,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,152
Insurance broker organization code?	3

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	163
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $7,989
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,989
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	184
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $962
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $962
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197350002

Policy instance

Insurance contract or identification number	2197350002
Number of Individuals Covered	15
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $341
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $341
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	29
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $158
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $158
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	56
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $92
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197350003

Policy instance

Insurance contract or identification number	2197350003
Number of Individuals Covered	121
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $1,733
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,733
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197350004

Policy instance

Insurance contract or identification number	2197350004
Number of Individuals Covered	35
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $318
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $318
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197350005

Policy instance

Insurance contract or identification number	2197350005
Number of Individuals Covered	10
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $114
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197350006

Policy instance

Insurance contract or identification number	2197350006
Number of Individuals Covered	1
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $8
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197360003

Policy instance

Insurance contract or identification number	2197360003
Number of Individuals Covered	42
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $1,699
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,699
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197360004

Policy instance

Insurance contract or identification number	2197360004
Number of Individuals Covered	16
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $623
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $623
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197360005

Policy instance

Insurance contract or identification number	2197360005
Number of Individuals Covered	3
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $47
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

2197360006

Policy instance

Insurance contract or identification number	2197360006
Number of Individuals Covered	1
Insurance policy start date	2021-12-01
Insurance policy end date	2022-12-01
Total amount of commissions paid to insurance broker	USD $1
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1
Insurance broker organization code?	3

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	163
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $8,708
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,708
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	33
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $203
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $203
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	112
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $23,084
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,264,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,084
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	171
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $986
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $986
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	172
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $3,838
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,838
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219736

Policy instance

Insurance contract or identification number	219736
Number of Individuals Covered	78
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $7,529
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,529
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	62
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $109
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109
Insurance broker organization code?	3

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	50
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $9,654
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $545,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,654
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	149
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $34,877
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,751,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,877
Insurance broker organization code?	3

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	27
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $7,959
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $398,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,959
Insurance broker organization code?	3

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	183
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $11,290
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,290
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	192
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $1,099
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,099
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	188
Insurance policy start date	2019-12-01
Insurance policy end date	2020-12-01
Total amount of commissions paid to insurance broker	USD $4,294
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,294
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219736

Policy instance

Insurance contract or identification number	219736
Number of Individuals Covered	97
Insurance policy start date	2019-12-01
Insurance policy end date	2020-12-01
Total amount of commissions paid to insurance broker	USD $9,682
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,682
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	43
Insurance policy start date	2019-12-01
Insurance policy end date	2020-12-01
Total amount of commissions paid to insurance broker	USD $247
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $247
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	77
Insurance policy start date	2019-12-01
Insurance policy end date	2020-12-01
Total amount of commissions paid to insurance broker	USD $122
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $122
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	167
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $32,529
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,643,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,529
Insurance broker organization code?	3

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	41
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $8,099
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $437,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,099
Insurance broker organization code?	3

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	210
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $8,750
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,750
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	235
Insurance policy start date	2018-12-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,306
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,306
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	235
Insurance policy start date	2018-12-01
Insurance policy end date	2019-12-01
Total amount of commissions paid to insurance broker	USD $5,746
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,746
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219736

Policy instance

Insurance contract or identification number	219736
Number of Individuals Covered	117
Insurance policy start date	2018-12-01
Insurance policy end date	2019-12-01
Total amount of commissions paid to insurance broker	USD $9,278
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,278
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	48
Insurance policy start date	2018-12-01
Insurance policy end date	2019-12-01
Total amount of commissions paid to insurance broker	USD $294
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $294
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	85
Insurance policy start date	2018-12-01
Insurance policy end date	2019-12-01
Total amount of commissions paid to insurance broker	USD $147
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $147
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	97
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-01
Total amount of commissions paid to insurance broker	USD $3,223
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,223
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	55
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-01
Total amount of commissions paid to insurance broker	USD $3,784
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,784
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219736

Policy instance

Insurance contract or identification number	219736
Number of Individuals Covered	124
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-01
Total amount of commissions paid to insurance broker	USD $11,639
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,639
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	216
Insurance policy start date	2017-12-01
Insurance policy end date	2018-12-01
Total amount of commissions paid to insurance broker	USD $9,481
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,481
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	231
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $1,120
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,120
Insurance broker organization code?	3

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	196
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $9,417
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,417
Insurance broker organization code?	3

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	44
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $10,685
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $467,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,685
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	155
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $36,466
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,425,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,466
Insurance broker organization code?	3

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	152
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $33,240
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,449,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,240
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	45
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $12,667
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $562,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,667
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	197
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $8,971
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,971
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	223
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $1,146
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,146
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	215
Insurance policy start date	2016-12-01
Insurance policy end date	2017-12-01
Total amount of commissions paid to insurance broker	USD $7,953
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,953
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219736

Policy instance

Insurance contract or identification number	219736
Number of Individuals Covered	151
Insurance policy start date	2016-12-01
Insurance policy end date	2017-12-01
Total amount of commissions paid to insurance broker	USD $7,395
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,395
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0011589501

Policy instance

Insurance contract or identification number	0011589501
Number of Individuals Covered	55
Insurance policy start date	2016-12-01
Insurance policy end date	2017-12-01
Total amount of commissions paid to insurance broker	USD $353
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $353
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0700476

Policy instance

Insurance contract or identification number	R0700476
Number of Individuals Covered	97
Insurance policy start date	2016-12-01
Insurance policy end date	2017-12-01
Total amount of commissions paid to insurance broker	USD $303
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $303
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6546600

Policy instance

Insurance contract or identification number	6546600
Number of Individuals Covered	128
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $30,343
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,392,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,343
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	58
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $14,214
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $690,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,214
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	189
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $9,794
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,794
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	212
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $1,041
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,041
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	213
Insurance policy start date	2015-12-01
Insurance policy end date	2016-12-01
Total amount of commissions paid to insurance broker	USD $8,328
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,328
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5522800

Policy instance

Insurance contract or identification number	5522800
Number of Individuals Covered	141
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $32,897
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,705,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,897
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	207
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,815
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,815
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	217
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,032
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,032
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	191
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $9,539
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,539
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATER, LLC

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

Policy contract number

1473700

Policy instance

Insurance contract or identification number	1473700
Number of Individuals Covered	48
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $11,424
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $523,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,424
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5522800

Policy instance

Insurance contract or identification number	5522800
Number of Individuals Covered	147
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $35,469
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,812,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,469
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	197
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $2,043
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,043
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATER, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	217
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,090
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,090
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

143700

Policy instance

Insurance contract or identification number	143700
Number of Individuals Covered	46
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $10,437
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $481,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,437
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	213
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,460
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,460
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5522800

Policy instance

Insurance contract or identification number	5522800
Number of Individuals Covered	151
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $32,414
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,617,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,414
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6363500

Policy instance

Insurance contract or identification number	6363500
Number of Individuals Covered	45
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $9,619
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $488,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,619
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	221
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,130
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,130
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	215
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,263
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,263
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	201
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $1,879
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,879
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATER, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	209
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,070
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,070
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	182
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $1,800
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,800
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATER, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

219735

Policy instance

Insurance contract or identification number	219735
Number of Individuals Covered	202
Insurance policy start date	2012-12-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $766
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $766
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6363500

Policy instance

Insurance contract or identification number	6363500
Number of Individuals Covered	46
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $9,136
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $460,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,136
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

G000AHB1

Policy instance

Insurance contract or identification number	G000AHB1
Number of Individuals Covered	192
Insurance policy start date	2012-10-01
Insurance policy end date	2012-12-01
Total amount of commissions paid to insurance broker	USD $218
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $218
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

G000AHB1

Policy instance

Insurance contract or identification number	G000AHB1
Number of Individuals Covered	192
Insurance policy start date	2012-10-01
Insurance policy end date	2012-12-01
Total amount of commissions paid to insurance broker	USD $485
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $485
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5522800

Policy instance

Insurance contract or identification number	5522800
Number of Individuals Covered	132
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $27,968
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,398,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,968
Insurance broker organization code?	3
Insurance broker name	CUMMINGS FRASER & ASSOCIATES, LLC

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

Policy contract number

G000AHB1

Policy instance

Insurance contract or identification number	G000AHB1
Number of Individuals Covered	168
Insurance policy start date	2010-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $1,193
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $5,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G000AHB1

Policy instance

Insurance contract or identification number	G000AHB1
Number of Individuals Covered	168
Insurance policy start date	2012-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $2,656
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )

Policy contract number

30021772

Policy instance

Insurance contract or identification number	30021772
Number of Individuals Covered	167
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $975
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

896

Policy instance

Insurance contract or identification number	896
Number of Individuals Covered	175
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,763
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

5522800

Policy instance

Insurance contract or identification number	5522800
Number of Individuals Covered	167
Insurance policy start date	2012-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $34,176
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,707,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

596

Policy instance

Insurance contract or identification number	596
Number of Individuals Covered	166
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,693
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $136
Insurance broker organization code?	3
Insurance broker name	TRUEBENEFITS LLC

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Company Name:	ASKO PROCESSING, INC.
Employer identification number (EIN):	910823269
NAIC Classification:	332900

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1967-07-19
Company Identification Number:	578080996
Legal Registered Office Address:	434 N 35TH ST SEATTLE United States of America (USA) 981038607