401k Plan data: HOLMAN DISTRIBUTION WELFARE PLAN plan

HOLMAN DISTRIBUTION WELFARE PLAN 401k Plan overview

Plan Name	HOLMAN DISTRIBUTION WELFARE PLAN
Plan identification number	501

HOLMAN DISTRIBUTION WELFARE 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

401k Sponsoring company profile

HOLMAN DISTRIBUTION has sponsored the creation of one or more 401k plans.

Company Name: HOLMAN DISTRIBUTION

Employer identification number (EIN): 930190040

NAIC Classification: 493100

Additional information about HOLMAN DISTRIBUTION

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 2030-09-11

Company Identification Number: 3426715

Legal Registered Office Address: 698 12TH ST NE STE 200

SALEM
United States of America (USA)
97301

More information about HOLMAN DISTRIBUTION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOLMAN DISTRIBUTION WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01
501 2015-01-01 BRIEN DOWNIE BRIEN DOWNIE 2016-10-10
501 2014-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2015-06-26
501 2013-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2014-07-21
501 2012-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2013-05-23
501 2011-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2012-06-06
501 2010-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2011-06-27
501 2009-01-01 ROBERT B. HARRINGTON ROBERT B. HARRINGTON 2010-07-08

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01
501	2015-01-01	BRIEN DOWNIE	BRIEN DOWNIE	2016-10-10
501	2014-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2015-06-26
501	2013-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2014-07-21
501	2012-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2013-05-23
501	2011-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2012-06-06
501	2010-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2011-06-27
501	2009-01-01	ROBERT B. HARRINGTON	ROBERT B. HARRINGTON	2010-07-08

Plan Statistics for HOLMAN DISTRIBUTION WELFARE PLAN

401k plan membership statisitcs for HOLMAN DISTRIBUTION WELFARE PLAN

Measure Date Value
2016: HOLMAN DISTRIBUTION WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 453
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 479
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 2016-01-01 479
2015: HOLMAN DISTRIBUTION WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 446
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 453
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 2015-01-01 453
2014: HOLMAN DISTRIBUTION WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 405
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 446
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 2014-01-01 446
2013: HOLMAN DISTRIBUTION WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 415
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 405
Total of all active and inactive participants 2013-01-01 405
2012: HOLMAN DISTRIBUTION WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 377
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 415
Total of all active and inactive participants 2012-01-01 415
2011: HOLMAN DISTRIBUTION WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 346
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 377
Total of all active and inactive participants 2011-01-01 377
2010: HOLMAN DISTRIBUTION WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 326
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 346
Total of all active and inactive participants 2010-01-01 346
2009: HOLMAN DISTRIBUTION WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 312
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 326
Total of all active and inactive participants 2009-01-01 326

Measure	Date	Value
2016: HOLMAN DISTRIBUTION WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	453
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	479
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	479
2015: HOLMAN DISTRIBUTION WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	446
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	453
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	453
2014: HOLMAN DISTRIBUTION WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	405
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	446
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	446
2013: HOLMAN DISTRIBUTION WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	415
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	405
Total of all active and inactive participants	2013-01-01	405
2012: HOLMAN DISTRIBUTION WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	377
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	415
Total of all active and inactive participants	2012-01-01	415
2011: HOLMAN DISTRIBUTION WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	377
Total of all active and inactive participants	2011-01-01	377
2010: HOLMAN DISTRIBUTION WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	326
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	346
Total of all active and inactive participants	2010-01-01	346
2009: HOLMAN DISTRIBUTION WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	312
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	326
Total of all active and inactive participants	2009-01-01	326

Form 5500 Responses for HOLMAN DISTRIBUTION WELFARE PLAN

2016: HOLMAN DISTRIBUTION WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: HOLMAN DISTRIBUTION WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: HOLMAN DISTRIBUTION WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: HOLMAN DISTRIBUTION WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HOLMAN DISTRIBUTION WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: HOLMAN DISTRIBUTION WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: HOLMAN DISTRIBUTION WELFARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: HOLMAN DISTRIBUTION WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	60
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $11,471
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $209,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,471
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

3702790000

Policy instance

Insurance contract or identification number	3702790000
Number of Individuals Covered	70
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $9,023
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $225,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,023
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFIT PLANNING LLC

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	453
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,485
Total amount of fees paid to insurance company	USD $742
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $98,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,485
Amount paid for insurance broker fees	742
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	71
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,300
Total amount of fees paid to insurance company	USD $315
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,300
Amount paid for insurance broker fees	315
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

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

Policy contract number

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	476
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,924
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,924
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	1124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $19,405
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $249,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,405
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

OWM9

Policy instance

Insurance contract or identification number	OWM9
Number of Individuals Covered	233
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of fees paid to insurance company	USD $41,762
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,331,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	41762
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

718723

Policy instance

Insurance contract or identification number	718723
Number of Individuals Covered	328
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $382,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	56
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $11,139
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $211,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,139
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	448
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,874
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,874
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	75
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,177
Total amount of fees paid to insurance company	USD $308
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,177
Amount paid for insurance broker fees	308
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	1106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,908
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $239,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,908
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

OWM9

Policy instance

Insurance contract or identification number	OWM9
Number of Individuals Covered	281
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of fees paid to insurance company	USD $31,477
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,017,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	31477
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

718723

Policy instance

Insurance contract or identification number	718723
Number of Individuals Covered	182
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Welfare Benefit Premiums Paid to Carrier	USD $378,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	446
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,274
Total amount of fees paid to insurance company	USD $691
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $92,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,274
Amount paid for insurance broker fees	691
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

718723

Policy instance

Insurance contract or identification number	718723
Number of Individuals Covered	180
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Welfare Benefit Premiums Paid to Carrier	USD $348,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

OWM9

Policy instance

Insurance contract or identification number	OWM9
Number of Individuals Covered	280
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $24,722
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $824,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,722
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	1063
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $19,302
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,302
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

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

Policy contract number

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	411
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,868
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,868
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	55
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $10,513
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $199,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,513
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	405
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,033
Total amount of fees paid to insurance company	USD $767
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $94,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,033
Amount paid for insurance broker fees	767
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	79
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,164
Total amount of fees paid to insurance company	USD $358
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,164
Amount paid for insurance broker fees	358
Additional information about fees paid to insurance broker	ADDT'L COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	1079
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $18,828
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $237,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,828
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	415
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,006
Total amount of fees paid to insurance company	USD $602
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $87,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,006
Amount paid for insurance broker fees	602
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	81
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $11,941
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $206,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,941
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	403
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,876
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,876
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	83
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,083
Total amount of fees paid to insurance company	USD $304
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,083
Amount paid for insurance broker fees	304
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

HOLMAN H223

Policy instance

Insurance contract or identification number	HOLMAN H223
Number of Individuals Covered	243
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $20,436
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $678,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,436
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0718723

Policy instance

Insurance contract or identification number	0718723
Number of Individuals Covered	187
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $254,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	60
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $11,237
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $189,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )

Policy contract number

723437

Policy instance

Insurance contract or identification number	723437
Number of Individuals Covered	137
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $10,065
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,738
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

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	369
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,805
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

60712

Policy instance

Insurance contract or identification number	60712
Number of Individuals Covered	195
Insurance policy start date	2011-01-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $6,793
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $226,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,022
Total amount of fees paid to insurance company	USD $351
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	1072
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,482
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $206,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

HOLMAN H223

Policy instance

Insurance contract or identification number	HOLMAN H223
Number of Individuals Covered	216
Insurance policy start date	2011-06-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,902
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $379,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0718723

Policy instance

Insurance contract or identification number	0718723
Number of Individuals Covered	407
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,981,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	377
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,255
Total amount of fees paid to insurance company	USD $611
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $81,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0718723

Policy instance

Insurance contract or identification number	0718723
Number of Individuals Covered	403
Insurance policy start date	2010-02-01
Insurance policy end date	2010-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,739,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05750852

Policy instance

Insurance contract or identification number	KM05750852
Number of Individuals Covered	994
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $14,455
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,455
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

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

Policy contract number

093895

Policy instance

Insurance contract or identification number	093895
Number of Individuals Covered	95
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,373
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,373
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

60712

Policy instance

Insurance contract or identification number	60712
Number of Individuals Covered	205
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $18,417
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $489,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,417
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

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

Policy contract number

30002111

Policy instance

Insurance contract or identification number	30002111
Number of Individuals Covered	346
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,749
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,749
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

227262

Policy instance

Insurance contract or identification number	227262
Number of Individuals Covered	49
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $9,054
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,054
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

093893

Policy instance

Insurance contract or identification number	093893
Number of Individuals Covered	346
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,325
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $72,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,325
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

506739

Policy instance

Insurance contract or identification number	506739
Number of Individuals Covered	522
Insurance policy start date	2010-01-01
Insurance policy end date	2010-01-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HOLMAN DISTRIBUTION
Employer identification number (EIN):	930190040
NAIC Classification:	493100

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	2030-09-11
Company Identification Number:	3426715
Legal Registered Office Address:	698 12TH ST NE STE 200 SALEM United States of America (USA) 97301