401k Plan data: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN plan

BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN
Plan identification number	510

BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS 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
Death benefits (include travel accident but not life insurance)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BELLARMINE PREPARATORY SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: BELLARMINE PREPARATORY SCHOOL

Employer identification number (EIN): 911109930

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-07-01 RICK TRIGGS 2023-12-13
510 2021-07-01 RICK TRIGGS 2023-01-04
510 2020-07-01 RICK TRIGGS 2021-11-15
510 2019-07-01 RICK TRIGGS 2021-03-22
510 2017-10-01
510 2016-10-01
510 2015-10-01 STEPHANIE CISAKOWSKI STEPHANIE CISAKOWSKI 2017-04-24
510 2014-10-01 STEPHANIE CISAKOWSKI STEPHANIE CISAKOWSKI 2016-04-15
510 2013-10-01 STEPHANIE CISAKOWSKI STEPHANIE CISAKOWSKI 2015-04-27
510 2012-10-01 STEPHANIE CISAKOWSKI
510 2011-10-01 STEPHANIE CISAKOWSKI STEPHANIE CISAKOWSKI 2013-04-15
510 2010-10-01 STEPHANIE CISAKOWSKI
510 2009-10-01 STEPHANIE CISAKOWSKI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2022-07-01	RICK TRIGGS	2023-12-13
510	2021-07-01	RICK TRIGGS	2023-01-04
510	2020-07-01	RICK TRIGGS	2021-11-15
510	2019-07-01	RICK TRIGGS	2021-03-22
510	2017-10-01
510	2016-10-01
510	2015-10-01	STEPHANIE CISAKOWSKI		STEPHANIE CISAKOWSKI	2017-04-24
510	2014-10-01	STEPHANIE CISAKOWSKI		STEPHANIE CISAKOWSKI	2016-04-15
510	2013-10-01	STEPHANIE CISAKOWSKI		STEPHANIE CISAKOWSKI	2015-04-27
510	2012-10-01	STEPHANIE CISAKOWSKI
510	2011-10-01	STEPHANIE CISAKOWSKI		STEPHANIE CISAKOWSKI	2013-04-15
510	2010-10-01	STEPHANIE CISAKOWSKI
510	2009-10-01	STEPHANIE CISAKOWSKI

Plan Statistics for BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 111
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 92
Number of retired or separated participants receiving benefits 2022-07-01 1
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 93
Number of employers contributing to the scheme 2022-07-01 0
2021: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 111
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 111
Number of employers contributing to the scheme 2021-07-01 0
2020: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 98
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 98
Number of employers contributing to the scheme 2020-07-01 0
2019: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 105
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 94
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 94
Number of employers contributing to the scheme 2019-07-01 0
2017: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 118
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 100
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 100
Number of employers contributing to the scheme 2017-10-01 0
2016: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 111
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 118
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 118
2015: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 111
Total of all active and inactive participants 2015-10-01 111
2014: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 134
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 119
Total of all active and inactive participants 2014-10-01 119
2013: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 125
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 134
Total of all active and inactive participants 2013-10-01 134
2012: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 122
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 125
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 125
2011: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 122
Total of all active and inactive participants 2011-10-01 122
2010: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 121
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 119
Number of retired or separated participants receiving benefits 2010-10-01 0
Number of other retired or separated participants entitled to future benefits 2010-10-01 0
Total of all active and inactive participants 2010-10-01 119
2009: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 121
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 121

Measure	Date	Value
2022: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	111
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	92
Number of retired or separated participants receiving benefits	2022-07-01	1
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	93
Number of employers contributing to the scheme	2022-07-01	0
2021: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	111
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	111
Number of employers contributing to the scheme	2021-07-01	0
2020: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	98
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	98
Number of employers contributing to the scheme	2020-07-01	0
2019: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	105
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	94
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	94
Number of employers contributing to the scheme	2019-07-01	0
2017: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	118
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	100
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	100
Number of employers contributing to the scheme	2017-10-01	0
2016: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	111
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	118
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	118
2015: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	111
Total of all active and inactive participants	2015-10-01	111
2014: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	134
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	119
Total of all active and inactive participants	2014-10-01	119
2013: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	125
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	134
Total of all active and inactive participants	2013-10-01	134
2012: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	122
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	125
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	125
2011: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	122
Total of all active and inactive participants	2011-10-01	122
2010: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	121
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	119
Number of retired or separated participants receiving benefits	2010-10-01	0
Number of other retired or separated participants entitled to future benefits	2010-10-01	0
Total of all active and inactive participants	2010-10-01	119
2009: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	121
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	121

Form 5500 Responses for BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN

2022: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2010: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2009: BELLARMINE PREPARATORY SCHOOL EMPLOYEE BENEFITS PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	14524
Policy instance	5
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number	1666600
Policy instance	4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6517500
Policy instance	3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	5369241
Policy instance	2
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	1
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	5369241
Policy instance	2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6517500
Policy instance	3
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number	1666600
Policy instance	4
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	5369241
Policy instance	2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6517500
Policy instance	3
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number	1666600
Policy instance	4
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	212726
Policy instance	5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	212726
Policy instance	5
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )
Policy contract number	1666600
Policy instance	4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6517500
Policy instance	3
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	5369241
Policy instance	2
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	4
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	1
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6517500
Policy instance	3
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	2
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number	10017606
Policy instance	1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	3
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6143700
Policy instance	6
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	3
APS HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	1210
Policy instance	1
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract number	WA398
Policy instance	2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6363700
Policy instance	5
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6143700
Policy instance	5
APS HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	0000
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	3
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6363700
Policy instance	1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	2
APS HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	00000000
Policy instance	4
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6143700
Policy instance	5
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	3
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6363700
Policy instance	1
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6363700
Policy instance	1
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6143700
Policy instance	5
APS HEALTHCARE, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	0000
Policy instance	4
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	WA07105W
Policy instance	3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number	6843
Policy instance	2

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Company Name:	BELLARMINE PREPARATORY SCHOOL
Employer identification number (EIN):	911109930
NAIC Classification:	611000