CONFEDERATED TRIBES OF SILETZ INDIANS; CHINOOK WINDS CASINO RESORT has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS
401k plan membership statisitcs for COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS
| Measure | Date | Value |
|---|
| 2022 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $714,725 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $467,965 |
| Total income from all sources (including contributions) | 2022-12-31 | $4,773,419 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $5,986,716 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $5,481,591 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $5,830,845 |
| Value of total assets at end of year | 2022-12-31 | $5,341,821 |
| Value of total assets at beginning of year | 2022-12-31 | $6,308,358 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $505,125 |
| Total interest from all sources | 2022-12-31 | $46,075 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $17,290 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $17,290 |
| Administrative expenses professional fees incurred | 2022-12-31 | $11,170 |
| Was this plan covered by a fidelity bond | 2022-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Participant contributions at end of year | 2022-12-31 | $0 |
| Participant contributions at beginning of year | 2022-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-12-31 | $250,424 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $1,096 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $68,255 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $91,180 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $95,152 |
| Total non interest bearing cash at end of year | 2022-12-31 | $910,240 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $1,091,117 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-1,213,297 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $4,627,096 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $5,840,393 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $2,211,578 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $2,916,079 |
| Income. Interest from US Government securities | 2022-12-31 | $46,075 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $484,755 |
| Asset value of US Government securities at end of year | 2022-12-31 | $1,892,773 |
| Asset value of US Government securities at beginning of year | 2022-12-31 | $2,225,490 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-1,120,791 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $5,580,421 |
| Employer contributions (assets) at end of year | 2022-12-31 | $326,134 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $7,417 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $4,996,836 |
| Contract administrator fees | 2022-12-31 | $493,955 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $623,545 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $372,813 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2022-12-31 | 261571066 |
| 2021 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $467,965 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $690,021 |
| Total income from all sources (including contributions) | 2021-12-31 | $7,048,901 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $5,022,694 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $4,542,880 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $6,610,024 |
| Value of total assets at end of year | 2021-12-31 | $6,308,358 |
| Value of total assets at beginning of year | 2021-12-31 | $4,504,207 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $479,814 |
| Total interest from all sources | 2021-12-31 | $39,524 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $21,457 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $21,457 |
| Administrative expenses professional fees incurred | 2021-12-31 | $11,170 |
| Was this plan covered by a fidelity bond | 2021-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Participant contributions at end of year | 2021-12-31 | $0 |
| Participant contributions at beginning of year | 2021-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $189,971 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $68,255 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $3,318 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $95,152 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $73,552 |
| Total non interest bearing cash at end of year | 2021-12-31 | $1,091,117 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $2,034,938 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $2,026,207 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $5,840,393 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $3,814,186 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $2,916,079 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $1,088,962 |
| Income. Interest from US Government securities | 2021-12-31 | $39,524 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $442,016 |
| Asset value of US Government securities at end of year | 2021-12-31 | $2,225,490 |
| Asset value of US Government securities at beginning of year | 2021-12-31 | $1,376,989 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $377,896 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $6,420,053 |
| Employer contributions (assets) at end of year | 2021-12-31 | $7,417 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $4,100,864 |
| Contract administrator fees | 2021-12-31 | $468,644 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $372,813 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $616,469 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2021-12-31 | 261571066 |
| 2020 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $690,021 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $908,963 |
| Total income from all sources (including contributions) | 2020-12-31 | $7,463,686 |
| Total loss/gain on sale of assets | 2020-12-31 | $0 |
| Total of all expenses incurred | 2020-12-31 | $4,369,506 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $3,903,244 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $7,348,057 |
| Value of total assets at end of year | 2020-12-31 | $4,504,207 |
| Value of total assets at beginning of year | 2020-12-31 | $1,628,969 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $466,262 |
| Total interest from all sources | 2020-12-31 | $5,722 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $24,255 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $24,255 |
| Administrative expenses professional fees incurred | 2020-12-31 | $11,096 |
| Was this plan covered by a fidelity bond | 2020-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Participant contributions at end of year | 2020-12-31 | $0 |
| Participant contributions at beginning of year | 2020-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $148,111 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $3,318 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $173,732 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $73,552 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $40,961 |
| Total non interest bearing cash at end of year | 2020-12-31 | $2,034,938 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $1,148,737 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $3,094,180 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $3,814,186 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $720,006 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $1,088,962 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $0 |
| Income. Interest from US Government securities | 2020-12-31 | $5,722 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $493,530 |
| Asset value of US Government securities at end of year | 2020-12-31 | $1,376,989 |
| Asset value of US Government securities at beginning of year | 2020-12-31 | $306,500 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $85,652 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $7,199,946 |
| Employer contributions (assets) at end of year | 2020-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $3,409,714 |
| Contract administrator fees | 2020-12-31 | $455,166 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $616,469 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $868,002 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2020-12-31 | 261571066 |
| 2019 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $908,963 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $908,963 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $1,096,040 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $1,096,040 |
| Total income from all sources (including contributions) | 2019-12-31 | $7,221,738 |
| Total income from all sources (including contributions) | 2019-12-31 | $7,221,738 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total of all expenses incurred | 2019-12-31 | $6,237,863 |
| Total of all expenses incurred | 2019-12-31 | $6,237,863 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,670,946 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,670,946 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $7,221,738 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $7,221,738 |
| Value of total assets at end of year | 2019-12-31 | $1,628,969 |
| Value of total assets at end of year | 2019-12-31 | $1,628,969 |
| Value of total assets at beginning of year | 2019-12-31 | $832,171 |
| Value of total assets at beginning of year | 2019-12-31 | $832,171 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $566,917 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $566,917 |
| Total interest from all sources | 2019-12-31 | $0 |
| Total interest from all sources | 2019-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $11,070 |
| Administrative expenses professional fees incurred | 2019-12-31 | $11,070 |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Participant contributions at end of year | 2019-12-31 | $0 |
| Participant contributions at end of year | 2019-12-31 | $0 |
| Participant contributions at beginning of year | 2019-12-31 | $0 |
| Participant contributions at beginning of year | 2019-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $207,839 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $207,839 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $173,732 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $173,732 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $162,860 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $162,860 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $40,961 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $40,961 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $16,944 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $16,944 |
| Total non interest bearing cash at end of year | 2019-12-31 | $1,148,737 |
| Total non interest bearing cash at end of year | 2019-12-31 | $1,148,737 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $367,689 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $367,689 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $983,875 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $720,006 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $720,006 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-263,869 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-263,869 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $468,909 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $468,909 |
| Asset value of US Government securities at end of year | 2019-12-31 | $306,500 |
| Asset value of US Government securities at end of year | 2019-12-31 | $306,500 |
| Asset value of US Government securities at beginning of year | 2019-12-31 | $301,622 |
| Asset value of US Government securities at beginning of year | 2019-12-31 | $301,622 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $7,013,899 |
| Contributions received in cash from employer | 2019-12-31 | $7,013,899 |
| Employer contributions (assets) at end of year | 2019-12-31 | $0 |
| Employer contributions (assets) at end of year | 2019-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $5,202,037 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $5,202,037 |
| Contract administrator fees | 2019-12-31 | $555,847 |
| Contract administrator fees | 2019-12-31 | $555,847 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $868,002 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $868,002 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $1,079,096 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $1,079,096 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | BLUEBIRD, CPAS |
| Accountancy firm name | 2019-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2019-12-31 | 261571066 |
| Accountancy firm EIN | 2019-12-31 | 261571066 |
| 2018 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $1,096,040 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $768,130 |
| Total income from all sources (including contributions) | 2018-12-31 | $6,597,286 |
| Total loss/gain on sale of assets | 2018-12-31 | $0 |
| Total of all expenses incurred | 2018-12-31 | $7,307,154 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $6,756,542 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $6,597,286 |
| Value of total assets at end of year | 2018-12-31 | $832,171 |
| Value of total assets at beginning of year | 2018-12-31 | $1,214,129 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $550,612 |
| Total interest from all sources | 2018-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $11,070 |
| Was this plan covered by a fidelity bond | 2018-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Participant contributions at end of year | 2018-12-31 | $0 |
| Participant contributions at beginning of year | 2018-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $25,252 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $162,860 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $38,767 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $16,944 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $14,505 |
| Total non interest bearing cash at end of year | 2018-12-31 | $367,689 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $1,175,362 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-709,868 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $-263,869 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $445,999 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $428,534 |
| Asset value of US Government securities at end of year | 2018-12-31 | $301,622 |
| Asset value of US Government securities at beginning of year | 2018-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $6,572,034 |
| Employer contributions (assets) at end of year | 2018-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $6,328,008 |
| Contract administrator fees | 2018-12-31 | $539,542 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $1,079,096 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $753,625 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2018-12-31 | 261571066 |
| 2017 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $768,130 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $689,067 |
| Total income from all sources (including contributions) | 2017-12-31 | $6,530,047 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $6,067,806 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $5,562,532 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $6,414,549 |
| Value of total assets at end of year | 2017-12-31 | $1,214,129 |
| Value of total assets at beginning of year | 2017-12-31 | $672,825 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $505,274 |
| Total interest from all sources | 2017-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $11,070 |
| Was this plan covered by a fidelity bond | 2017-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Participant contributions at end of year | 2017-12-31 | $0 |
| Participant contributions at beginning of year | 2017-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $38,767 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $110,275 |
| Other income not declared elsewhere | 2017-12-31 | $115,498 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $14,505 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $39,928 |
| Total non interest bearing cash at end of year | 2017-12-31 | $1,175,362 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $562,550 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $462,241 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $445,999 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-16,242 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $538,846 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $6,414,549 |
| Employer contributions (assets) at end of year | 2017-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $5,023,686 |
| Contract administrator fees | 2017-12-31 | $494,204 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $753,625 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $649,139 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2017-12-31 | 261571066 |
| 2016 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $689,067 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $668,260 |
| Total income from all sources (including contributions) | 2016-12-31 | $6,182,902 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $6,005,267 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $5,481,899 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $6,095,466 |
| Value of total assets at end of year | 2016-12-31 | $672,825 |
| Value of total assets at beginning of year | 2016-12-31 | $474,383 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $523,368 |
| Total interest from all sources | 2016-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $11,070 |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Participant contributions at end of year | 2016-12-31 | $0 |
| Participant contributions at beginning of year | 2016-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $110,275 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $58,632 |
| Other income not declared elsewhere | 2016-12-31 | $87,436 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $39,928 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $59,283 |
| Total non interest bearing cash at end of year | 2016-12-31 | $562,550 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $415,751 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $177,635 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $-16,242 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $-193,877 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $524,053 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $6,095,466 |
| Employer contributions (assets) at end of year | 2016-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $4,957,846 |
| Contract administrator fees | 2016-12-31 | $512,298 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $649,139 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $608,977 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2016-12-31 | 261571066 |
| 2015 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $668,260 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $1,021,447 |
| Total income from all sources (including contributions) | 2015-12-31 | $5,828,355 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $5,499,050 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $4,972,809 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $5,793,517 |
| Value of total assets at end of year | 2015-12-31 | $474,383 |
| Value of total assets at beginning of year | 2015-12-31 | $498,265 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $526,241 |
| Total interest from all sources | 2015-12-31 | $12 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $10,160 |
| Was this plan covered by a fidelity bond | 2015-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Participant contributions at end of year | 2015-12-31 | $0 |
| Participant contributions at beginning of year | 2015-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $58,632 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $0 |
| Other income not declared elsewhere | 2015-12-31 | $34,826 |
| Administrative expenses (other) incurred | 2015-12-31 | $516,081 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $59,283 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $108,855 |
| Total non interest bearing cash at end of year | 2015-12-31 | $415,751 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $496,184 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $329,305 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $-193,877 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $-523,182 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $12 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $536,415 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $5,793,517 |
| Employer contributions (assets) at end of year | 2015-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $2,081 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $4,436,394 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $608,977 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $912,592 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Liabilities. Value of acquisition indebtedness at end of year | 2015-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2015-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | BLUEBIRD, CPAS |
| Accountancy firm EIN | 2015-12-31 | 261571066 |
| 2014 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $1,021,447 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $895,987 |
| Total income from all sources (including contributions) | 2014-12-31 | $5,551,858 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $6,636,065 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $6,083,811 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $5,484,240 |
| Value of total assets at end of year | 2014-12-31 | $498,265 |
| Value of total assets at beginning of year | 2014-12-31 | $1,457,012 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $552,254 |
| Total interest from all sources | 2014-12-31 | $1,142 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $10,160 |
| Was this plan covered by a fidelity bond | 2014-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Participant contributions at end of year | 2014-12-31 | $0 |
| Participant contributions at beginning of year | 2014-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $143,531 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $0 |
| Other income not declared elsewhere | 2014-12-31 | $66,476 |
| Administrative expenses (other) incurred | 2014-12-31 | $542,094 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $108,855 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $36,833 |
| Total non interest bearing cash at end of year | 2014-12-31 | $496,184 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $1,310,499 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-1,084,207 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $-523,182 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $561,025 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $1,142 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $539,891 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $5,484,240 |
| Employer contributions (assets) at end of year | 2014-12-31 | $2,081 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $2,982 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $5,543,920 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $912,592 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $859,154 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Liabilities. Value of acquisition indebtedness at end of year | 2014-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2014-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | EGGHART & ASSOCIATES, LLC, CPAS |
| Accountancy firm EIN | 2014-12-31 | 261571066 |
| 2013 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2013-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2013-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $895,987 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $673,618 |
| Expenses. Interest paid | 2013-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2013-12-31 | $0 |
| Total income from all sources (including contributions) | 2013-12-31 | $5,772,753 |
| Total loss/gain on sale of assets | 2013-12-31 | $0 |
| Total of all expenses incurred | 2013-12-31 | $6,414,632 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $5,890,212 |
| Expenses. Certain deemed distributions of participant loans | 2013-12-31 | $0 |
| Value of total corrective distributions | 2013-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $5,718,944 |
| Value of total assets at end of year | 2013-12-31 | $1,457,012 |
| Value of total assets at beginning of year | 2013-12-31 | $1,876,522 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $524,420 |
| Total income from rents | 2013-12-31 | $0 |
| Total interest from all sources | 2013-12-31 | $319 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $0 |
| Administrative expenses professional fees incurred | 2013-12-31 | $10,160 |
| Was this plan covered by a fidelity bond | 2013-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $0 |
| Participant contributions at end of year | 2013-12-31 | $0 |
| Participant contributions at beginning of year | 2013-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $143,531 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $41,415 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $0 |
| Other income not declared elsewhere | 2013-12-31 | $53,490 |
| Administrative expenses (other) incurred | 2013-12-31 | $514,260 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $36,833 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $47,375 |
| Total non interest bearing cash at end of year | 2013-12-31 | $1,310,499 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $1,828,249 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Income. Non cash contributions | 2013-12-31 | $0 |
| Value of net income/loss | 2013-12-31 | $-641,879 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $561,025 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $1,202,904 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $0 |
| Interest on participant loans | 2013-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2013-12-31 | $0 |
| Interest earned on other investments | 2013-12-31 | $0 |
| Income. Interest from US Government securities | 2013-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2013-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $319 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $581,503 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2013-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2013-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2013-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $5,718,944 |
| Employer contributions (assets) at end of year | 2013-12-31 | $2,982 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $6,858 |
| Income. Dividends from preferred stock | 2013-12-31 | $0 |
| Income. Dividends from common stock | 2013-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $5,308,709 |
| Contract administrator fees | 2013-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $859,154 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $626,243 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Aggregate proceeds on sale of assets | 2013-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2013-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2013-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | EGGHART & ASSOCIATES, LLC, CPAS |
| Accountancy firm EIN | 2013-12-31 | 261571066 |
| 2012 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2012-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $673,618 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $598,370 |
| Expenses. Interest paid | 2012-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2012-12-31 | $0 |
| Total income from all sources (including contributions) | 2012-12-31 | $5,822,013 |
| Total loss/gain on sale of assets | 2012-12-31 | $0 |
| Total of all expenses incurred | 2012-12-31 | $5,427,351 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $5,136,178 |
| Expenses. Certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of total corrective distributions | 2012-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $5,784,036 |
| Value of total assets at end of year | 2012-12-31 | $1,876,522 |
| Value of total assets at beginning of year | 2012-12-31 | $1,406,612 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $291,173 |
| Total interest from all sources | 2012-12-31 | $817 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $0 |
| Administrative expenses professional fees incurred | 2012-12-31 | $9,800 |
| Was this plan covered by a fidelity bond | 2012-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $0 |
| Participant contributions at end of year | 2012-12-31 | $0 |
| Participant contributions at beginning of year | 2012-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $41,415 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $38,461 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $11,337 |
| Other income not declared elsewhere | 2012-12-31 | $37,160 |
| Administrative expenses (other) incurred | 2012-12-31 | $281,373 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $47,375 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $37,717 |
| Total non interest bearing cash at end of year | 2012-12-31 | $1,828,249 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $1,354,989 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Income. Non cash contributions | 2012-12-31 | $0 |
| Value of net income/loss | 2012-12-31 | $394,662 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $1,202,904 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $808,242 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $0 |
| Interest on participant loans | 2012-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2012-12-31 | $0 |
| Interest earned on other investments | 2012-12-31 | $0 |
| Income. Interest from US Government securities | 2012-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2012-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $817 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $674,944 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2012-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2012-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2012-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $5,784,036 |
| Employer contributions (assets) at end of year | 2012-12-31 | $6,858 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $13,162 |
| Income. Dividends from preferred stock | 2012-12-31 | $0 |
| Income. Dividends from common stock | 2012-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $4,461,234 |
| Contract administrator fees | 2012-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $626,243 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $549,316 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Aggregate proceeds on sale of assets | 2012-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2012-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2012-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | EGGHART & ASSOCIATES, LLC, CPAS |
| Accountancy firm EIN | 2012-12-31 | 261571066 |
| 2011 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2011-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $598,370 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $889,942 |
| Expenses. Interest paid | 2011-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2011-12-31 | $0 |
| Total income from all sources (including contributions) | 2011-12-31 | $5,681,722 |
| Total loss/gain on sale of assets | 2011-12-31 | $0 |
| Total of all expenses incurred | 2011-12-31 | $5,072,421 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $4,762,367 |
| Expenses. Certain deemed distributions of participant loans | 2011-12-31 | $0 |
| Value of total corrective distributions | 2011-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $5,619,618 |
| Value of total assets at end of year | 2011-12-31 | $1,406,612 |
| Value of total assets at beginning of year | 2011-12-31 | $883,762 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $310,054 |
| Total income from rents | 2011-12-31 | $0 |
| Total interest from all sources | 2011-12-31 | $588 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-12-31 | $0 |
| Administrative expenses professional fees incurred | 2011-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2011-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $0 |
| Participant contributions at end of year | 2011-12-31 | $0 |
| Participant contributions at beginning of year | 2011-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $38,461 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $38,461 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $11,337 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $101,574 |
| Other income not declared elsewhere | 2011-12-31 | $61,516 |
| Administrative expenses (other) incurred | 2011-12-31 | $310,054 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $37,717 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $33,931 |
| Total non interest bearing cash at end of year | 2011-12-31 | $1,354,989 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $618,058 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Income. Non cash contributions | 2011-12-31 | $0 |
| Value of net income/loss | 2011-12-31 | $609,301 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $808,242 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $-6,180 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $0 |
| Interest on participant loans | 2011-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2011-12-31 | $0 |
| Interest earned on other investments | 2011-12-31 | $0 |
| Income. Interest from US Government securities | 2011-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2011-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $588 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $628,090 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2011-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2011-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2011-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $5,619,618 |
| Employer contributions (assets) at end of year | 2011-12-31 | $13,162 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $227,243 |
| Income. Dividends from preferred stock | 2011-12-31 | $0 |
| Income. Dividends from common stock | 2011-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $4,134,277 |
| Contract administrator fees | 2011-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $549,316 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $754,437 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Aggregate proceeds on sale of assets | 2011-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2011-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2011-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2011-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | EGGHART & ASSOCIATES, LLC, CPAS |
| Accountancy firm EIN | 2011-12-31 | 261571066 |
| 2010 : COHO BENEFITS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS 2010 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2010-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $889,942 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $1,073,200 |
| Expenses. Interest paid | 2010-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2010-12-31 | $0 |
| Total income from all sources (including contributions) | 2010-12-31 | $5,554,049 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $5,683,282 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $5,384,057 |
| Expenses. Certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Value of total corrective distributions | 2010-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $5,519,208 |
| Value of total assets at end of year | 2010-12-31 | $883,762 |
| Value of total assets at beginning of year | 2010-12-31 | $1,196,253 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $299,225 |
| Total income from rents | 2010-12-31 | $0 |
| Total interest from all sources | 2010-12-31 | $34,841 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2010-12-31 | $0 |
| Administrative expenses professional fees incurred | 2010-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $0 |
| Participant contributions at end of year | 2010-12-31 | $0 |
| Participant contributions at beginning of year | 2010-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2010-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $38,461 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $38,461 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $101,574 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $303,727 |
| Other income not declared elsewhere | 2010-12-31 | $0 |
| Administrative expenses (other) incurred | 2010-12-31 | $299,225 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $33,931 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $16,171 |
| Total non interest bearing cash at end of year | 2010-12-31 | $618,058 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $1,139,487 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Income. Non cash contributions | 2010-12-31 | $0 |
| Value of net income/loss | 2010-12-31 | $-129,233 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $-6,180 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $123,053 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $0 |
| Interest on participant loans | 2010-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2010-12-31 | $0 |
| Interest earned on other investments | 2010-12-31 | $0 |
| Income. Interest from US Government securities | 2010-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2010-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $34,841 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $559,362 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2010-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2010-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2010-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2010-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $5,519,208 |
| Employer contributions (assets) at end of year | 2010-12-31 | $227,243 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $18,305 |
| Income. Dividends from preferred stock | 2010-12-31 | $0 |
| Income. Dividends from common stock | 2010-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $4,824,695 |
| Contract administrator fees | 2010-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $754,437 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $753,302 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Aggregate proceeds on sale of assets | 2010-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2010-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2010-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | EGGHART & ASSOCIATES, LLC, CPA |
| Accountancy firm EIN | 2010-12-31 | 261571066 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 87892 |
| Policy instance | 5 |
| Insurance contract or identification number | 87892 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $21,879 | | Total amount of fees paid to insurance company | USD $573 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $145,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,879 | | Amount paid for insurance broker fees | 573 | | Additional information about fees paid to insurance broker | SALES COMMISSION / ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 624 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,982 | | 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 | 879891 |
| Policy instance | 2 |
| Insurance contract or identification number | 879891 | | Number of Individuals Covered | 773 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,388 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $344,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2388 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 417002414117 |
| Policy instance | 3 |
| Insurance contract or identification number | 417002414117 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $485,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 481822 |
| Policy instance | 4 |
| Insurance contract or identification number | 481822 | | Number of Individuals Covered | 639 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $25,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 481822 |
| Policy instance | 4 |
| Insurance contract or identification number | 481822 | | Number of Individuals Covered | 602 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 417002414117 |
| Policy instance | 3 |
| Insurance contract or identification number | 417002414117 | | Number of Individuals Covered | 620 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $442,269 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 624 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,456 | | 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 | 879891 |
| Policy instance | 2 |
| Insurance contract or identification number | 879891 | | Number of Individuals Covered | 760 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,432 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $324,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2432 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 879891 |
| Policy instance | 2 |
| Insurance contract or identification number | 879891 | | Number of Individuals Covered | 812 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,125 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $275,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2125 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 417002414117 |
| Policy instance | 3 |
| Insurance contract or identification number | 417002414117 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $493,181 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 662 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,751 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 780 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 3 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 744 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $30,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 7058-20190-C |
| Policy instance | 2 |
| Insurance contract or identification number | 7058-20190-C | | Number of Individuals Covered | 754 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $472,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 7058-20180-C |
| Policy instance | 2 |
| Insurance contract or identification number | 7058-20180-C | | Number of Individuals Covered | 762 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $426,620 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 770 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 3 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 730 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $30,318 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 799 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6,011 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6011 | | Additional information about fees paid to insurance broker | VISION INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INS. SERVICES |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | LGS00972-17 |
| Policy instance | 2 |
| Insurance contract or identification number | LGS00972-17 | | Number of Individuals Covered | 802 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $19,111 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $477,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,111 | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INSURANCE SER |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-016682-00 |
| Policy instance | 3 |
| Insurance contract or identification number | 01-016682-00 | | Number of Individuals Covered | 927 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $86,473 | | Total amount of fees paid to insurance company | USD $15,250 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $517,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $86,473 | | Amount paid for insurance broker fees | 15250 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INSURANCE SER |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 4 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 761 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $31,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-016682-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 01-016682-00 | | Number of Individuals Covered | 857 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $84,908 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $500,371 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,176 | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INSURANCE SER |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | LGS00972-15 |
| Policy instance | 3 |
| Insurance contract or identification number | LGS00972-15 | | Number of Individuals Covered | 799 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $42,800 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $475,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,800 | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INSURANCE SER |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 798 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6,063 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3079 | | Additional information about fees paid to insurance broker | VISION INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | CONOVER ALMOND VALLEY INSURANCE SER |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 1 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 757 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,389 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $31,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1389 | | Additional information about fees paid to insurance broker | DENTAL CLAIMS | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANML |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANML | | Number of Individuals Covered | 885 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $80,641 | | Total amount of fees paid to insurance company | USD $12,501 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $512,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $80,641 | | Amount paid for insurance broker fees | 12501 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | LGS00972-14 |
| Policy instance | 3 |
| Insurance contract or identification number | LGS00972-14 | | Number of Individuals Covered | 802 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $33,499 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $478,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,499 | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 1 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 797 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,674 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1674 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 802 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,166 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $61,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,166 | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00481822 |
| Policy instance | 5 |
| Insurance contract or identification number | 00481822 | | Number of Individuals Covered | 811 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $33,472 | | 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: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 783 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,122 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $51,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,122 | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-011830-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-011830-000 | | Number of Individuals Covered | 788 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $21,211 | | Total amount of fees paid to insurance company | USD $18,309 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $530,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,211 | | Amount paid for insurance broker fees | 6524 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ALTERNATIVE RISK SOLUTIONS, LLC |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 678049G |
| Policy instance | 3 |
| Insurance contract or identification number | 678049G | | Number of Individuals Covered | 937 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $399 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $399 | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ANML |
| Policy instance | 4 |
| Insurance contract or identification number | G000ANML | | Number of Individuals Covered | 889 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $83,348 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $527,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $83,348 | | Insurance broker organization code? | 3 | | Insurance broker name | ALMOND VALLEY INSURANCE SERVICES |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 678049G |
| Policy instance | 3 |
| Insurance contract or identification number | 678049G | | Number of Individuals Covered | 1066 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $43,894 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $439,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,677 | | Insurance broker organization code? | 3 | | Insurance broker name | DENVER MANAGEMENT ADVISORS |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-011830-000 |
| Policy instance | 4 |
| Insurance contract or identification number | 16-011830-000 | | Number of Individuals Covered | 836 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $67,737 | | Total amount of fees paid to insurance company | USD $6,352 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $338,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,737 | | Amount paid for insurance broker fees | 6352 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ALTERNATIVE RISK SOLUTIONS, LLC |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 841 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,143 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $51,424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,844 | | Insurance broker organization code? | 3 | | Insurance broker name | DENVER MANAGEMENT ADVISORS INC. |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-011830-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-011830-000 | | Number of Individuals Covered | 832 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $113,575 | | Total amount of fees paid to insurance company | USD $4,928 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $567,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $113,575 | | Amount paid for insurance broker fees | 4928 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ALTERNATIVE RISK SOLUTIONS, LLC |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-011830-000 |
| Policy instance | 4 |
| Insurance contract or identification number | 16-011830-000 | | Number of Individuals Covered | 832 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $113,575 | | Total amount of fees paid to insurance company | USD $4,928 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $567,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 1 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 810 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $5,496 | | Total amount of fees paid to insurance company | USD $13,191 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $54,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 816 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $5,588 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $55,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 678049G |
| Policy instance | 3 |
| Insurance contract or identification number | 678049G | | Number of Individuals Covered | 1034 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $44,829 | | Total amount of fees paid to insurance company | USD $11,023 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $447,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H54800 |
| Policy instance | 1 |
| Insurance contract or identification number | H54800 | | Number of Individuals Covered | 955 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $57,876 | | Total amount of fees paid to insurance company | USD $14,702 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $538,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,893 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14702 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | DENVER MANAGEMENT ADVISORS |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 3 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 810 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $5,496 | | Total amount of fees paid to insurance company | USD $13,191 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $54,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,496 | | Amount paid for insurance broker fees | 13191 | | Additional information about fees paid to insurance broker | ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | DENVER MANAGEMENT ADVISORS |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12219738 |
| Policy instance | 2 |
| Insurance contract or identification number | 12219738 | | Number of Individuals Covered | 1059 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $6,724 | | Total amount of fees paid to insurance company | USD $15,998 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $67,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,724 | | Amount paid for insurance broker fees | 15998 | | Additional information about fees paid to insurance broker | ADMIN FEES | | Insurance broker organization code? | 3 | | Insurance broker name | DENVER MANAGEMENT ADVISORS |
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