401k Plan data: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN plan

CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 401k Plan overview

Plan Name	CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN
Plan identification number	501

CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CASCADE MICROTECH, INC. has sponsored the creation of one or more 401k plans.

Company Name: CASCADE MICROTECH, INC.

Employer identification number (EIN): 930856709

NAIC Classification: 334410

Additional information about CASCADE MICROTECH, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1984-02-24

Company Identification Number: 17500919

Legal Registered Office Address: 8130 SW BEAVERTON-HILLSDALE HIGHWAY

PORTLAND
United States of America (USA)
97225

More information about CASCADE MICROTECH, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 CHRISTINA GEORGE
501 2015-01-01 ERIN DAVIS ERIN DAVIS 2016-07-28
501 2014-01-01 ELLEN RAIM ELLEN RAIM 2015-10-02
501 2013-01-01 JEFF KILLIAN JEFF KILLIAN 2014-07-28
501 2012-01-01 JEFF KILLIAN JEFF KILLIAN 2013-08-26
501 2011-01-01 JEFF KILLIAN JEFF KILLIAN 2012-06-05
501 2010-01-01 JEFF KILLIAN JEFF KILLIAN 2011-08-15
501 2009-01-01 JEFF KILLIAN

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01	CHRISTINA GEORGE
501	2015-01-01	ERIN DAVIS	ERIN DAVIS	2016-07-28
501	2014-01-01	ELLEN RAIM	ELLEN RAIM	2015-10-02
501	2013-01-01	JEFF KILLIAN	JEFF KILLIAN	2014-07-28
501	2012-01-01	JEFF KILLIAN	JEFF KILLIAN	2013-08-26
501	2011-01-01	JEFF KILLIAN	JEFF KILLIAN	2012-06-05
501	2010-01-01	JEFF KILLIAN	JEFF KILLIAN	2011-08-15
501	2009-01-01	JEFF KILLIAN

Plan Statistics for CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN

401k plan membership statisitcs for CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN

Measure Date Value
2016: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 293
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 252
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 293
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 293
2014: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 239
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 252
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 255
2013: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 235
Number of retired or separated participants receiving benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 238
2012: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 208
Number of retired or separated participants receiving benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 212
2011: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 201
Total of all active and inactive participants 2011-01-01 201
2010: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 252
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 248
Total of all active and inactive participants 2010-01-01 248
2009: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 309
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 252
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 252
Total participants 2009-01-01 0

Measure	Date	Value
2016: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	293
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	252
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	293
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	293
2014: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	239
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	252
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	255
2013: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	235
Number of retired or separated participants receiving benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	238
2012: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	208
Number of retired or separated participants receiving benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	212
2011: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	201
Total of all active and inactive participants	2011-01-01	201
2010: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	252
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	248
Total of all active and inactive participants	2010-01-01	248
2009: CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	309
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	252
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	252
Total participants	2009-01-01	0

Form 5500 Responses for CASCADE MICROTECH, INC. FLEXIBLE SPENDING ACCOUNT PLAN

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

Insurance Providers Used on plan

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643 OR22

Policy instance

Insurance contract or identification number	Z1643 OR22
Number of Individuals Covered	130
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,778
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,778
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	246
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,133,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149479

Policy instance

Insurance contract or identification number	000010149479
Number of Individuals Covered	326
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,047
Total amount of fees paid to insurance company	USD $5,064
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,047
Amount paid for insurance broker fees	5064
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149478

Policy instance

Insurance contract or identification number	000010149478
Number of Individuals Covered	293
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,532
Total amount of fees paid to insurance company	USD $3,396
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) AD&D
Welfare Benefit Premiums Paid to Carrier	USD $56,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,532
Amount paid for insurance broker fees	3396
Additional information about fees paid to insurance broker	TPA FEE,ENROLLMENT,PRINTING,MAILING BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

400001000 14022

Policy instance

Insurance contract or identification number	400001000 14022
Number of Individuals Covered	200
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,341
Total amount of fees paid to insurance company	USD $3,777
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,341
Amount paid for insurance broker fees	3777
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA FEES
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

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

Policy contract number

52113

Policy instance

Insurance contract or identification number	52113
Number of Individuals Covered	5
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

02550C

Policy instance

Insurance contract or identification number	02550C
Number of Individuals Covered	1
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $5,504
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,504
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING

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

Policy contract number

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	189
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $417
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $4,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $417
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149479

Policy instance

Insurance contract or identification number	000010149479
Number of Individuals Covered	253
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $295
Total amount of fees paid to insurance company	USD $2,719
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $295
Amount paid for insurance broker fees	2719
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	222
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $942,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643 OR22

Policy instance

Insurance contract or identification number	Z1643 OR22
Number of Individuals Covered	97
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,337
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,337
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

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

Policy contract number

52113

Policy instance

Insurance contract or identification number	52113
Number of Individuals Covered	5
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149478

Policy instance

Insurance contract or identification number	000010149478
Number of Individuals Covered	254
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,525
Total amount of fees paid to insurance company	USD $3,057
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) AD&D
Welfare Benefit Premiums Paid to Carrier	USD $36,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,525
Amount paid for insurance broker fees	3057
Additional information about fees paid to insurance broker	TPA FEE,ENROLLMENT,PRINTING,MAILING BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149480

Policy instance

Insurance contract or identification number	000010149480
Number of Individuals Covered	252
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,385
Total amount of fees paid to insurance company	USD $2,976
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $35,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,385
Amount paid for insurance broker fees	2976
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00605801

Policy instance

Insurance contract or identification number	00605801
Number of Individuals Covered	222
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $574,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

02550C

Policy instance

Insurance contract or identification number	02550C
Number of Individuals Covered	3
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $3,993
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,993
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING

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

Policy contract number

8460592

Policy instance

Insurance contract or identification number	8460592
Number of Individuals Covered	18
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $575
Total amount of fees paid to insurance company	USD $63
Other welfare benefits provided	ACCIDENTT/CANCER/CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $173
Insurance broker organization code?	3
Amount paid for insurance broker fees	63
Additional information about fees paid to insurance broker	ADDTL COMP
Insurance broker name	CUSTOM BENEFIT PROGRAMS INC

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

Policy contract number

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	253
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,481
Total amount of fees paid to insurance company	USD $274
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $34,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,481
Amount paid for insurance broker fees	274
Additional information about fees paid to insurance broker	ADDTL COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	87
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,532
Total amount of fees paid to insurance company	USD $3,634
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,532
Amount paid for insurance broker fees	3634
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA FEES
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

02550C

Policy instance

Insurance contract or identification number	02550C
Number of Individuals Covered	3
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $3,274
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,274
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00605801

Policy instance

Insurance contract or identification number	00605801
Number of Individuals Covered	133
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $453,588
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

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	233
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,288
Total amount of fees paid to insurance company	USD $314
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $38,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,288
Amount paid for insurance broker fees	314
Additional information about fees paid to insurance broker	ADDTL COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03356982

Policy instance

Insurance contract or identification number	03356982
Number of Individuals Covered	220
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	204
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $966,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	BONUS RETENTION
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149479

Policy instance

Insurance contract or identification number	000010149479
Number of Individuals Covered	232
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,523
Total amount of fees paid to insurance company	USD $6,802
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,523
Amount paid for insurance broker fees	6802
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149478

Policy instance

Insurance contract or identification number	000010149478
Number of Individuals Covered	232
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,802
Total amount of fees paid to insurance company	USD $2,862
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,802
Amount paid for insurance broker fees	2862
Additional information about fees paid to insurance broker	FEES BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149480

Policy instance

Insurance contract or identification number	000010149480
Number of Individuals Covered	232
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,665
Total amount of fees paid to insurance company	USD $2,808
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $31,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,665
Amount paid for insurance broker fees	2808
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	73
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,775
Total amount of fees paid to insurance company	USD $3,594
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,775
Amount paid for insurance broker fees	3594
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA FEES
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

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

Policy contract number

52113

Policy instance

Insurance contract or identification number	52113
Number of Individuals Covered	5
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643 OR22

Policy instance

Insurance contract or identification number	Z1643 OR22
Number of Individuals Covered	92
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,125
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,125
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149480

Policy instance

Insurance contract or identification number	000010149480
Number of Individuals Covered	216
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,840
Total amount of fees paid to insurance company	USD $1,280
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $25,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,840
Amount paid for insurance broker fees	1280
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03356982

Policy instance

Insurance contract or identification number	03356982
Number of Individuals Covered	204
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643 OR22

Policy instance

Insurance contract or identification number	Z1643 OR22
Number of Individuals Covered	86
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,028
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,028
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	194
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $1,164
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $762,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1164
Additional information about fees paid to insurance broker	BONUS RETENTION
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149479

Policy instance

Insurance contract or identification number	000010149479
Number of Individuals Covered	215
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,965
Total amount of fees paid to insurance company	USD $2,975
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,965
Amount paid for insurance broker fees	2975
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010149478

Policy instance

Insurance contract or identification number	000010149478
Number of Individuals Covered	267
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,858
Total amount of fees paid to insurance company	USD $1,286
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	OTHER (SPECIFY) AD&D
Welfare Benefit Premiums Paid to Carrier	USD $25,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,858
Amount paid for insurance broker fees	1286
Additional information about fees paid to insurance broker	PRINTING/HR SERVICES/ENROLLMENT MAILING, TPA SVCS
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	154
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,115
Total amount of fees paid to insurance company	USD $1,705
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,115
Amount paid for insurance broker fees	1705
Additional information about fees paid to insurance broker	PRINTING, HR SERVICES, ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	NFP NATIONAL ACCT SVCS INC

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

Policy contract number

Policy instance

Number of Individuals Covered	5
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00605801

Policy instance

Insurance contract or identification number	00605801
Number of Individuals Covered	206
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $46,651
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $375,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,651
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING

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

Policy contract number

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	213
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,325
Total amount of fees paid to insurance company	USD $266
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $39,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,325
Amount paid for insurance broker fees	266
Additional information about fees paid to insurance broker	ADDTL COMP
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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

Policy contract number

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	201
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,776
Total amount of fees paid to insurance company	USD $289
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $38,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	201
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,571
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	201
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,312
Long Term Disability Insurance Welfare Benefit	Yes
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

03356982

Policy instance

Insurance contract or identification number	03356982
Number of Individuals Covered	193
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643

Policy instance

Insurance contract or identification number	Z1643
Number of Individuals Covered	77
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $981
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	201
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,328
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	204
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,415
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $758,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

5733

Policy instance

Insurance contract or identification number	5733
Number of Individuals Covered	218
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $17,310
Total amount of fees paid to insurance company	USD $903
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $798,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,310
Amount paid for insurance broker fees	903
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	HEESTAND COMPANY

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

605801

Policy instance

Insurance contract or identification number	605801
Number of Individuals Covered	272
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $31,089
Total amount of fees paid to insurance company	USD $1,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $345,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,089
Amount paid for insurance broker fees	1000
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	HEESTAND COMPANY

WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )

Policy contract number

Z1643

Policy instance

Insurance contract or identification number	Z1643
Number of Individuals Covered	84
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,706
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,706
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03356982

Policy instance

Insurance contract or identification number	03356982
Number of Individuals Covered	244
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $115
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $115
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	248
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,889
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,889
Insurance broker organization code?	3
Insurance broker name	HEESTAND COMPANY

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

Policy contract number

023871

Policy instance

Insurance contract or identification number	023871
Number of Individuals Covered	244
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,761
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $39,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,949
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	248
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,853
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,853
Insurance broker organization code?	3
Insurance broker name	HEESTAND COMPANY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

603741

Policy instance

Insurance contract or identification number	603741
Number of Individuals Covered	248
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,633
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,633
Insurance broker organization code?	3
Insurance broker name	HEESTAND COMPANY

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Company Name:	CASCADE MICROTECH, INC.
Employer identification number (EIN):	930856709
NAIC Classification:	334410

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1984-02-24
Company Identification Number:	17500919
Legal Registered Office Address:	8130 SW BEAVERTON-HILLSDALE HIGHWAY PORTLAND United States of America (USA) 97225