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PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 401k Plan overview

Plan NamePACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN
Plan identification number 501

PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

PACIFIC CREST INDUSTRIES, INC., DBA BELLMONT CABINET CO. has sponsored the creation of one or more 401k plans.

Company Name:PACIFIC CREST INDUSTRIES, INC., DBA BELLMONT CABINET CO.
Employer identification number (EIN):911127279
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01MARTHA KOCH2024-04-17
5012022-01-01MARTHA KOCH2023-07-10
5012021-01-01MARTHA KOCH2022-03-22
5012020-01-01MARTHA KOCH2021-04-06
5012019-01-01MARTHA KOCH2020-04-20
5012018-01-01
5012017-01-01
5012016-01-01MARTHA A KOCH
5012015-01-01MARTHA KOCH
5012014-01-01MARTHA KOCH
5012013-01-01MARTHA KOCH
5012012-01-01STEVE BELL
5012011-01-01STEVEN BELL
5012010-01-01SUSAN C TINNIN
5012009-01-01STEVE BELL

Plan Statistics for PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN

401k plan membership statisitcs for PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN

Measure Date Value
2023: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01358
Total number of active participants reported on line 7a of the Form 55002023-01-01312
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01312
Number of employers contributing to the scheme2023-01-010
2022: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01354
Total number of active participants reported on line 7a of the Form 55002022-01-01358
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01358
Number of employers contributing to the scheme2022-01-010
2021: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01297
Total number of active participants reported on line 7a of the Form 55002021-01-01354
Number of retired or separated participants receiving benefits2021-01-013
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01357
Number of employers contributing to the scheme2021-01-010
2020: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01327
Total number of active participants reported on line 7a of the Form 55002020-01-01292
Number of retired or separated participants receiving benefits2020-01-015
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01297
Number of employers contributing to the scheme2020-01-010
2019: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01307
Total number of active participants reported on line 7a of the Form 55002019-01-01326
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01327
Number of employers contributing to the scheme2019-01-010
2018: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01310
Total number of active participants reported on line 7a of the Form 55002018-01-01307
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01308
Number of employers contributing to the scheme2018-01-010
2017: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01271
Total number of active participants reported on line 7a of the Form 55002017-01-01310
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01310
2016: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01288
Total number of active participants reported on line 7a of the Form 55002016-01-01271
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01271
2015: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01180
Total number of active participants reported on line 7a of the Form 55002015-01-01288
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01288
2014: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01163
Total number of active participants reported on line 7a of the Form 55002014-01-01180
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01180
2013: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01130
Total number of active participants reported on line 7a of the Form 55002013-01-01163
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01163
2012: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01126
Total number of active participants reported on line 7a of the Form 55002012-01-01130
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01130
2011: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01111
Total number of active participants reported on line 7a of the Form 55002011-01-01126
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01126
2010: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0192
Total number of active participants reported on line 7a of the Form 55002010-01-01111
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01111
2009: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01145
Total number of active participants reported on line 7a of the Form 55002009-01-0192
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0192

Form 5500 Responses for PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN

2023: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: PACIFIC CREST INDUSTRIES HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 3
Insurance contract or identification numberGLUG0AVL7
Number of Individuals Covered312
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $5,346
Total amount of fees paid to insurance companyUSD $3,926
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $50,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberWA855
Policy instance 2
Insurance contract or identification numberWA855
Number of Individuals Covered31
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,176
Total amount of fees paid to insurance companyUSD $1,627
Dental Insurance Welfare BenefitYes
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: 53031 )
Policy contract number12254111
Policy instance 1
Insurance contract or identification number12254111
Number of Individuals Covered239
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,184
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,609
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: 53031 )
Policy contract number12254111
Policy instance 1
Insurance contract or identification number12254111
Number of Individuals Covered271
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,212
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,550
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 numberGLUG0AVL7
Policy instance 2
Insurance contract or identification numberGLUG0AVL7
Number of Individuals Covered358
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,230
Total amount of fees paid to insurance companyUSD $3,055
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $49,420
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: 53031 )
Policy contract number12254111
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number12254111
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 2
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF697A
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number12254111
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF697A
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number12254111
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number12254111
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AVL7
Policy instance 3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF697A-C
Policy instance 2
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVB142, VB143
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVL7
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVB142
Policy instance 2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 4
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05592530
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number213274
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05592530
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number213274
Policy instance 3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVB142
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05592530
Policy instance 1
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVB142
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05592530
Policy instance 2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6238100
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )
Policy contract number12254111
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05592530
Policy instance 2
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6238100
Policy instance 1

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