401k Plan data: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN plan

BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN
Plan identification number	502

BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT 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 Other welfare benefit cover

401k Sponsoring company profile

BANK OF THE SIERRA has sponsored the creation of one or more 401k plans.

Company Name: BANK OF THE SIERRA

Employer identification number (EIN): 942431437

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about BANK OF THE SIERRA

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0826388

More information about BANK OF THE SIERRA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-04-01
502 2020-04-01
502 2019-04-01
502 2018-04-01
502 2017-04-01 DEANNA SPITZER DEANNA SPITZER 2018-10-13
502 2016-04-01 DEANNA SPITZER DEANNA SPITZER 2017-09-22
502 2015-04-01 DEANNA SPITZER DEANNA SPITZER 2016-10-05
502 2014-04-01 DEANNA SPITZER DEANNA SPITZER 2015-10-09
502 2013-04-01 DEANNA SPITZER DEANNA SPITZER 2014-10-23
502 2012-04-01 DONALD SOWERS 2013-10-17 DONALD SOWERS 2013-10-17
502 2011-04-01 DONALD SOWERS 2012-08-22 DONALD SOWERS 2012-08-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-04-01
502	2020-04-01
502	2019-04-01
502	2018-04-01
502	2017-04-01	DEANNA SPITZER		DEANNA SPITZER	2018-10-13
502	2016-04-01	DEANNA SPITZER		DEANNA SPITZER	2017-09-22
502	2015-04-01	DEANNA SPITZER		DEANNA SPITZER	2016-10-05
502	2014-04-01	DEANNA SPITZER		DEANNA SPITZER	2015-10-09
502	2013-04-01	DEANNA SPITZER		DEANNA SPITZER	2014-10-23
502	2012-04-01	DONALD SOWERS	2013-10-17	DONALD SOWERS	2013-10-17
502	2011-04-01	DONALD SOWERS	2012-08-22	DONALD SOWERS	2012-08-22

Plan Statistics for BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 334
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 323
Total of all active and inactive participants 2021-04-01 323
2020: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 414
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 334
Total of all active and inactive participants 2020-04-01 334
2019: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 553
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 414
Number of retired or separated participants receiving benefits 2019-04-01 4
Total of all active and inactive participants 2019-04-01 418
2018: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-04-01 307
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 553
Total of all active and inactive participants 2018-04-01 553
2017: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 307
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 388
Total of all active and inactive participants 2017-04-01 388
2016: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 431
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 307
Total of all active and inactive participants 2016-04-01 307
2015: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 437
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 431
Total of all active and inactive participants 2015-04-01 431
2014: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 406
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 437
Total of all active and inactive participants 2014-04-01 437
2013: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-04-01 411
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 406
Total of all active and inactive participants 2013-04-01 406
2012: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-04-01 253
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 411
Total of all active and inactive participants 2012-04-01 411
2011: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-01 322
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 253
Total of all active and inactive participants 2011-04-01 253

Measure	Date	Value
2021: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	334
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	323
Total of all active and inactive participants	2021-04-01	323
2020: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	414
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	334
Total of all active and inactive participants	2020-04-01	334
2019: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	553
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	414
Number of retired or separated participants receiving benefits	2019-04-01	4
Total of all active and inactive participants	2019-04-01	418
2018: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-04-01	307
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	553
Total of all active and inactive participants	2018-04-01	553
2017: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	307
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	388
Total of all active and inactive participants	2017-04-01	388
2016: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	431
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	307
Total of all active and inactive participants	2016-04-01	307
2015: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	437
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	431
Total of all active and inactive participants	2015-04-01	431
2014: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	406
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	437
Total of all active and inactive participants	2014-04-01	437
2013: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-04-01	411
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	406
Total of all active and inactive participants	2013-04-01	406
2012: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-04-01	253
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	411
Total of all active and inactive participants	2012-04-01	411
2011: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-01	322
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	253
Total of all active and inactive participants	2011-04-01	253

Form 5500 Responses for BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN

2021: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2013: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2012: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2011: BANK OF THE SIERRA CONSOLIDATED EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95546

Policy instance

Insurance contract or identification number	95546
Number of Individuals Covered	72
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $4,899
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $24,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,899
Insurance broker organization code?	3

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

Policy contract number

605528

Policy instance

Insurance contract or identification number	605528
Number of Individuals Covered	26
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,817
Total amount of fees paid to insurance company	USD $218
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $282,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,817
Insurance broker organization code?	3
Amount paid for insurance broker fees	218
Additional information about fees paid to insurance broker	BONUS

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

915

Policy instance

Insurance contract or identification number	915
Number of Individuals Covered	605
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,476
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: 00000 )

Policy contract number

30003043

Policy instance

Insurance contract or identification number	30003043
Number of Individuals Covered	313
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,117
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,404
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E9679390

Policy instance

Insurance contract or identification number	E9679390
Number of Individuals Covered	3
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $71
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26
Insurance broker organization code?	3

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

Policy contract number

000010216112

Policy instance

Insurance contract or identification number	000010216112
Number of Individuals Covered	451
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $1,532
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,532
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Number of Individuals Covered	454
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $135,788
Total amount of fees paid to insurance company	USD $13,540
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,376,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $135,788
Insurance broker organization code?	3
Amount paid for insurance broker fees	13540
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

225910

Policy instance

Insurance contract or identification number	225910
Number of Individuals Covered	25
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,179
Total amount of fees paid to insurance company	USD $182
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $255,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,179
Insurance broker organization code?	3
Amount paid for insurance broker fees	182
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

25482

Policy instance

Insurance contract or identification number	25482
Number of Individuals Covered	286
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $11,375
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,375
Insurance broker organization code?	3

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

Policy contract number

10216111

Policy instance

Insurance contract or identification number	10216111
Number of Individuals Covered	451
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $3,848
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,848
Insurance broker organization code?	3

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

Policy contract number

10255662

Policy instance

Insurance contract or identification number	10255662
Number of Individuals Covered	129
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $4,964
Total amount of fees paid to insurance company	USD $0
Unemployment Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,964
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

204145

Policy instance

Insurance contract or identification number	204145
Number of Individuals Covered	28
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $858
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $5,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $858
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38597

Policy instance

Insurance contract or identification number	38597
Number of Individuals Covered	104
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $3,972
Total amount of fees paid to insurance company	USD $298
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $28,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,535
Insurance broker organization code?	4
Amount paid for insurance broker fees	298
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38567

Policy instance

Insurance contract or identification number	38567
Number of Individuals Covered	124
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $7,906
Total amount of fees paid to insurance company	USD $555
Other welfare benefits provided	CRITICAL ILLNESS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,849
Insurance broker organization code?	3
Amount paid for insurance broker fees	555
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Number of Individuals Covered	531
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $144,948
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,529,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $144,948
Insurance broker organization code?	3

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

Policy contract number

000010216112

Policy instance

Insurance contract or identification number	000010216112
Number of Individuals Covered	469
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $3,828
Total amount of fees paid to insurance company	USD $747
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,828
Insurance broker organization code?	3
Amount paid for insurance broker fees	747
Additional information about fees paid to insurance broker	BROKER BONUS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E9679390

Policy instance

Insurance contract or identification number	E9679390
Number of Individuals Covered	3
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Total amount of commissions paid to insurance broker	USD $86
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,760
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	0

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30003043

Policy instance

Insurance contract or identification number	30003043
Number of Individuals Covered	333
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,809
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1809
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

915

Policy instance

Insurance contract or identification number	915
Number of Individuals Covered	619
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

605528

Policy instance

Insurance contract or identification number	605528
Number of Individuals Covered	48
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $11,692
Total amount of fees paid to insurance company	USD $938
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $341,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,692
Insurance broker organization code?	3
Amount paid for insurance broker fees	938
Additional information about fees paid to insurance broker	BONUS

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

Policy contract number

225910

Policy instance

Insurance contract or identification number	225910
Number of Individuals Covered	41
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $9,481
Total amount of fees paid to insurance company	USD $630
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $271,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,481
Insurance broker organization code?	3
Amount paid for insurance broker fees	630
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

25482

Policy instance

Insurance contract or identification number	25482
Number of Individuals Covered	295
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $11,450
Total amount of fees paid to insurance company	USD $1,560
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,450
Insurance broker organization code?	3
Amount paid for insurance broker fees	1560
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

10216111

Policy instance

Insurance contract or identification number	10216111
Number of Individuals Covered	469
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $1,597
Total amount of fees paid to insurance company	USD $216
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,597
Insurance broker organization code?	3
Amount paid for insurance broker fees	216
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

10255662

Policy instance

Insurance contract or identification number	10255662
Number of Individuals Covered	145
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $4,971
Total amount of fees paid to insurance company	USD $537
Unemployment Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,971
Insurance broker organization code?	3
Amount paid for insurance broker fees	537
Additional information about fees paid to insurance broker	BROKER BONUS

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

204145

Policy instance

Insurance contract or identification number	204145
Number of Individuals Covered	31
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,151
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $6,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,151
Insurance broker organization code?	4

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38597

Policy instance

Insurance contract or identification number	38597
Number of Individuals Covered	104
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $15,068
Total amount of fees paid to insurance company	USD $1,799
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $34,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,006
Insurance broker organization code?	3
Amount paid for insurance broker fees	1799
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38567

Policy instance

Insurance contract or identification number	38567
Number of Individuals Covered	131
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $10,104
Total amount of fees paid to insurance company	USD $2,266
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $45,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,256
Insurance broker organization code?	3
Amount paid for insurance broker fees	2266
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95546

Policy instance

Insurance contract or identification number	95546
Number of Individuals Covered	69
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $2,120
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $27,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,120
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

95546

Policy instance

Insurance contract or identification number	95546
Number of Individuals Covered	75
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $3,639
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $18,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,639
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Number of Individuals Covered	557
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $159,563
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,000,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $159,563
Insurance broker organization code?	3

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

Policy contract number

25482

Policy instance

Insurance contract or identification number	25482
Number of Individuals Covered	214
Insurance policy start date	2019-10-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $3,113
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,113
Insurance broker organization code?	3

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

Policy contract number

10216111

Policy instance

Insurance contract or identification number	10216111
Number of Individuals Covered	492
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $1,358
Total amount of fees paid to insurance company	USD $146
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,181
Amount paid for insurance broker fees	146
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

10255662

Policy instance

Insurance contract or identification number	10255662
Number of Individuals Covered	129
Insurance policy start date	2019-10-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $1,059
Total amount of fees paid to insurance company	USD $0
Unemployment Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,059
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

204145

Policy instance

Insurance contract or identification number	204145
Number of Individuals Covered	36
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $904
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $5,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $904
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38597

Policy instance

Insurance contract or identification number	38597
Number of Individuals Covered	108
Insurance policy start date	2019-10-19
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $18,657
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $53,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,638
Insurance broker organization code?	1

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

38567

Policy instance

Insurance contract or identification number	38567
Number of Individuals Covered	131
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $7,989
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $36,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,967
Insurance broker organization code?	3

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

Policy contract number

225910

Policy instance

Insurance contract or identification number	225910
Number of Individuals Covered	50
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $10,228
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $294,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,109
Insurance broker organization code?	3

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

Policy contract number

000010216112

Policy instance

Insurance contract or identification number	000010216112
Number of Individuals Covered	492
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-30
Total amount of commissions paid to insurance broker	USD $4,062
Total amount of fees paid to insurance company	USD $492
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,444
Amount paid for insurance broker fees	492
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E9679390

Policy instance

Insurance contract or identification number	E9679390
Number of Individuals Covered	4
Insurance policy start date	2019-03-01
Insurance policy end date	2020-02-28
Total amount of commissions paid to insurance broker	USD $106
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30003043

Policy instance

Insurance contract or identification number	30003043
Number of Individuals Covered	359
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $686
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $686
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

915

Policy instance

Insurance contract or identification number	915
Number of Individuals Covered	652
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

605528

Policy instance

Insurance contract or identification number	605528
Number of Individuals Covered	56
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $8,424
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $237,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,853
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V0975

Policy instance

Insurance contract or identification number	V0975
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $30,425
Total amount of fees paid to insurance company	USD $1,196
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $185,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,710
Amount paid for insurance broker fees	186
Insurance broker organization code?	3

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

Policy contract number

000010216112

Policy instance

Insurance contract or identification number	000010216112
Number of Individuals Covered	517
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-30
Total amount of commissions paid to insurance broker	USD $4,498
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,498
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $184,858
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,905,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184,858
Insurance broker organization code?	3

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

Policy contract number

000010216111

Policy instance

Insurance contract or identification number	000010216111
Number of Individuals Covered	517
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $1,516
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,516
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E9679390

Policy instance

Insurance contract or identification number	E9679390
Number of Individuals Covered	4
Insurance policy start date	2018-03-01
Insurance policy end date	2019-02-28
Total amount of commissions paid to insurance broker	USD $90
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,941
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
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30003043

Policy instance

Insurance contract or identification number	30003043
Number of Individuals Covered	381
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $1,948
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,948
Insurance broker organization code?	3

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

915

Policy instance

Insurance contract or identification number	915
Number of Individuals Covered	695
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

225910-0000

Policy instance

Insurance contract or identification number	225910-0000
Number of Individuals Covered	137
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $21,546
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $621,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,430
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V0975

Policy instance

Insurance contract or identification number	V0975
Number of Individuals Covered	291
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $36,107
Total amount of fees paid to insurance company	USD $420
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $208,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,805
Amount paid for insurance broker fees	49
Insurance broker organization code?	3

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

Policy contract number

225910-0000

Policy instance

Insurance contract or identification number	225910-0000
Number of Individuals Covered	137
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $21,546
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $621,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,430
Insurance broker organization code?	3
Insurance broker name	BUCKMAN MITCHELL FINANCIAL SERVICES

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

915

Policy instance

Insurance contract or identification number	915
Number of Individuals Covered	700
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,120
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: 00000 )

Policy contract number

30003043

Policy instance

Insurance contract or identification number	30003043
Number of Individuals Covered	387
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $1,362
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,362
Insurance broker organization code?	3
Insurance broker name	BUCKMAN MITCHELL FINANCIAL SERVICES

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E9679390

Policy instance

Insurance contract or identification number	E9679390
Number of Individuals Covered	5
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $97
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36
Insurance broker organization code?	3
Insurance broker name	JAMES WALTERS

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

Policy contract number

000010216112

Policy instance

Insurance contract or identification number	000010216112
Number of Individuals Covered	538
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-30
Total amount of commissions paid to insurance broker	USD $4,283
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,452
Insurance broker organization code?	3
Insurance broker name	BUCKMAN MITCHELL INC

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Number of Individuals Covered	527
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

280406

Policy instance

Insurance contract or identification number	280406
Number of Individuals Covered	548
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $154,319
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $3,146,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $154,319
Insurance broker organization code?	3
Insurance broker name	BUCKMAN MITCHELL FINANCIAL SERVICES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

V0975

Policy instance

Insurance contract or identification number	V0975
Number of Individuals Covered	295
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of commissions paid to insurance broker	USD $44,838
Total amount of fees paid to insurance company	USD $1,424
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $230,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,200
Amount paid for insurance broker fees	509
Insurance broker organization code?	3
Insurance broker name	TERRANCE LUCZAJ

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Company Name:	BANK OF THE SIERRA
Employer identification number (EIN):	942431437
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0826388