WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN
Plan identification number	502

WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

WESTERN ENGINEERING CONTRACTORS INC has sponsored the creation of one or more 401k plans.

Company Name:	WESTERN ENGINEERING CONTRACTORS INC
Employer identification number (EIN):	942901297
NAIC Classification:	237310
NAIC Description:	Highway, Street, and Bridge Construction

Additional information about WESTERN ENGINEERING CONTRACTORS INC

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	1983-05-03
Company Identification Number:	C1140950
Legal Registered Office Address:	3171 Rippey Road Loomis United States of America (USA) 95650

More information about WESTERN ENGINEERING CONTRACTORS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-06-01
502	2021-06-01
502	2020-06-01
502	2019-06-01
502	2018-06-01
502	2017-06-01	JOEL SCHNEIDER
502	2016-06-01	JOEL SCHNEIDER
502	2015-06-01
502	2014-06-01
502	2013-06-01
502	2012-06-01	DON CARROLL
502	2011-06-01	DON CARROLL
502	2009-06-01
502	2008-06-01
502	2007-06-01
502	2006-06-01
502	2005-06-01
502	2004-06-01
502	2003-06-01
502	2002-06-01
502	2001-06-01
502	2000-06-01
502	1999-06-01
502	1998-06-01
502	1997-06-01
502	1996-06-01
502	1995-06-01
502	1994-06-01
502	1993-06-01

Plan Statistics for WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN

401k plan membership statisitcs for WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN

Measure	Date	Value
2022: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	86
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	93
Number of retired or separated participants receiving benefits	2022-06-01	1
Number of other retired or separated participants entitled to future benefits	2022-06-01	0
Total of all active and inactive participants	2022-06-01	94
2021: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	93
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	80
Number of retired or separated participants receiving benefits	2021-06-01	2
Number of other retired or separated participants entitled to future benefits	2021-06-01	0
Total of all active and inactive participants	2021-06-01	82
2020: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	100
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	91
Number of retired or separated participants receiving benefits	2020-06-01	2
Number of other retired or separated participants entitled to future benefits	2020-06-01	0
Total of all active and inactive participants	2020-06-01	93
2019: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	99
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	99
Number of retired or separated participants receiving benefits	2019-06-01	1
Number of other retired or separated participants entitled to future benefits	2019-06-01	0
Total of all active and inactive participants	2019-06-01	100
2018: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	97
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	97
Number of retired or separated participants receiving benefits	2018-06-01	0
Number of other retired or separated participants entitled to future benefits	2018-06-01	2
Total of all active and inactive participants	2018-06-01	99
2017: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	96
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	97
Number of retired or separated participants receiving benefits	2017-06-01	0
Number of other retired or separated participants entitled to future benefits	2017-06-01	0
Total of all active and inactive participants	2017-06-01	97
2016: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	98
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	96
Number of retired or separated participants receiving benefits	2016-06-01	0
Number of other retired or separated participants entitled to future benefits	2016-06-01	0
Total of all active and inactive participants	2016-06-01	96
2015: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	85
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	98
Total of all active and inactive participants	2015-06-01	98
2014: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	78
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	84
Number of retired or separated participants receiving benefits	2014-06-01	1
Total of all active and inactive participants	2014-06-01	85
2013: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	80
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	76
Number of retired or separated participants receiving benefits	2013-06-01	2
Total of all active and inactive participants	2013-06-01	78
2012: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	77
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	79
Number of retired or separated participants receiving benefits	2012-06-01	1
Total of all active and inactive participants	2012-06-01	80
Total participants	2012-06-01	80
2011: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	81
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	76
Number of retired or separated participants receiving benefits	2011-06-01	1
Total of all active and inactive participants	2011-06-01	77
Total participants	2011-06-01	77
2009: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	98
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	70
Number of retired or separated participants receiving benefits	2009-06-01	2
Total of all active and inactive participants	2009-06-01	72
Total participants	2009-06-01	72
2008: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year	2008-06-01	98
Total number of active participants reported on line 7a of the Form 5500	2008-06-01	96
Number of retired or separated participants receiving benefits	2008-06-01	2
Total of all active and inactive participants	2008-06-01	98
Total participants	2008-06-01	98
2007: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year	2007-06-01	99
Total number of active participants reported on line 7a of the Form 5500	2007-06-01	96
Number of retired or separated participants receiving benefits	2007-06-01	2
Total of all active and inactive participants	2007-06-01	98
Total participants	2007-06-01	98
2006: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year	2006-06-01	103
Total number of active participants reported on line 7a of the Form 5500	2006-06-01	98
Number of retired or separated participants receiving benefits	2006-06-01	1
Total of all active and inactive participants	2006-06-01	99
Total participants	2006-06-01	99
2005: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year	2005-06-01	118
Total number of active participants reported on line 7a of the Form 5500	2005-06-01	100
Number of retired or separated participants receiving benefits	2005-06-01	3
Total of all active and inactive participants	2005-06-01	103
Total participants	2005-06-01	103
2004: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year	2004-06-01	119
Total number of active participants reported on line 7a of the Form 5500	2004-06-01	116
Number of retired or separated participants receiving benefits	2004-06-01	2
Total of all active and inactive participants	2004-06-01	118
Total participants	2004-06-01	118
2003: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2003 401k membership
Total participants, beginning-of-year	2003-06-01	96
Total number of active participants reported on line 7a of the Form 5500	2003-06-01	116
Number of retired or separated participants receiving benefits	2003-06-01	3
Total of all active and inactive participants	2003-06-01	119
Total participants	2003-06-01	119
2002: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2002 401k membership
Total participants, beginning-of-year	2002-06-01	95
Total number of active participants reported on line 7a of the Form 5500	2002-06-01	95
Number of retired or separated participants receiving benefits	2002-06-01	1
Total of all active and inactive participants	2002-06-01	96
Total participants	2002-06-01	96
2001: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2001 401k membership
Total participants, beginning-of-year	2001-06-01	95
Total number of active participants reported on line 7a of the Form 5500	2001-06-01	91
Number of retired or separated participants receiving benefits	2001-06-01	4
Total of all active and inactive participants	2001-06-01	95
Total participants	2001-06-01	95
2000: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2000 401k membership
Total participants, beginning-of-year	2000-06-01	82
Total number of active participants reported on line 7a of the Form 5500	2000-06-01	94
Number of retired or separated participants receiving benefits	2000-06-01	1
Total of all active and inactive participants	2000-06-01	95
Total participants	2000-06-01	95
1999: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1999 401k membership
Total participants, beginning-of-year	1999-06-01	80
Total number of active participants reported on line 7a of the Form 5500	1999-06-01	82
Total of all active and inactive participants	1999-06-01	82
Total participants	1999-06-01	82
1998: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1998 401k membership
Total participants, beginning-of-year	1998-06-01	61
Total number of active participants reported on line 7a of the Form 5500	1998-06-01	80
Total of all active and inactive participants	1998-06-01	80
Total participants	1998-06-01	80
1997: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1997 401k membership
Total participants, beginning-of-year	1997-06-01	56
Total number of active participants reported on line 7a of the Form 5500	1997-06-01	61
Total of all active and inactive participants	1997-06-01	61
Total participants	1997-06-01	61
1996: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1996 401k membership
Total participants, beginning-of-year	1996-06-01	50
Total number of active participants reported on line 7a of the Form 5500	1996-06-01	56
Total of all active and inactive participants	1996-06-01	56
Total participants	1996-06-01	56
1995: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1995 401k membership
Total participants, beginning-of-year	1995-06-01	41
Total number of active participants reported on line 7a of the Form 5500	1995-06-01	50
Total of all active and inactive participants	1995-06-01	50
Total participants	1995-06-01	50
1994: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1994 401k membership
Total participants, beginning-of-year	1994-06-01	42
Total number of active participants reported on line 7a of the Form 5500	1994-06-01	41
Total of all active and inactive participants	1994-06-01	41
Total participants	1994-06-01	41
1993: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1993 401k membership
Total participants, beginning-of-year	1993-06-01	0
Total number of active participants reported on line 7a of the Form 5500	1993-06-01	42
Total of all active and inactive participants	1993-06-01	42
Total participants	1993-06-01	42

Financial Data on WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN

Measure	Date	Value
2023 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2023 401k financial data
Total income from all sources	2023-05-31	$855,674
Expenses. Total of all expenses incurred	2023-05-31	$855,674
Benefits paid (including direct rollovers)	2023-05-31	$855,674
Value of fidelity bond covering the plan	2023-05-31	$1,000,000
Total contributions received or receivable from participants	2023-05-31	$248,615
Net income (gross income less expenses)	2023-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2023-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2023-05-31	$0
Total contributions received or receivable from employer(s)	2023-05-31	$607,059
2022 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2022 401k financial data
Total income from all sources	2022-05-31	$740,539
Expenses. Total of all expenses incurred	2022-05-31	$740,539
Benefits paid (including direct rollovers)	2022-05-31	$740,539
Value of fidelity bond covering the plan	2022-05-31	$1,000,000
Total contributions received or receivable from participants	2022-05-31	$315,197
Net income (gross income less expenses)	2022-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2022-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2022-05-31	$0
Total contributions received or receivable from employer(s)	2022-05-31	$425,342
2021 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 401k financial data
Total income from all sources	2021-05-31	$792,891
Expenses. Total of all expenses incurred	2021-05-31	$792,891
Benefits paid (including direct rollovers)	2021-05-31	$792,891
Value of fidelity bond covering the plan	2021-05-31	$1,000,000
Total contributions received or receivable from participants	2021-05-31	$222,926
Net income (gross income less expenses)	2021-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2021-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2021-05-31	$0
Total contributions received or receivable from employer(s)	2021-05-31	$569,965
2020 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 401k financial data
Total income from all sources	2020-05-31	$722,608
Expenses. Total of all expenses incurred	2020-05-31	$722,608
Benefits paid (including direct rollovers)	2020-05-31	$722,608
Value of fidelity bond covering the plan	2020-05-31	$1,000,000
Total contributions received or receivable from participants	2020-05-31	$256,251
Net income (gross income less expenses)	2020-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2020-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2020-05-31	$0
Total contributions received or receivable from employer(s)	2020-05-31	$466,357
2019 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2019 401k financial data
Total income from all sources	2019-05-31	$781,133
Expenses. Total of all expenses incurred	2019-05-31	$781,133
Benefits paid (including direct rollovers)	2019-05-31	$781,133
Value of fidelity bond covering the plan	2019-05-31	$1,000,000
Total contributions received or receivable from participants	2019-05-31	$265,501
Net income (gross income less expenses)	2019-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2019-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-05-31	$0
Total contributions received or receivable from employer(s)	2019-05-31	$515,632
2018 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2018 401k financial data
Total income from all sources	2018-05-31	$789,351
Expenses. Total of all expenses incurred	2018-05-31	$789,351
Benefits paid (including direct rollovers)	2018-05-31	$789,351
Value of fidelity bond covering the plan	2018-05-31	$1,000,000
Total contributions received or receivable from participants	2018-05-31	$290,080
Net income (gross income less expenses)	2018-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2018-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2018-05-31	$0
Total contributions received or receivable from employer(s)	2018-05-31	$499,271
2017 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2017 401k financial data
Total income from all sources	2017-05-31	$790,985
Expenses. Total of all expenses incurred	2017-05-31	$790,985
Benefits paid (including direct rollovers)	2017-05-31	$790,985
Value of fidelity bond covering the plan	2017-05-31	$1,000,000
Total contributions received or receivable from participants	2017-05-31	$279,962
Net income (gross income less expenses)	2017-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2017-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-05-31	$0
Total contributions received or receivable from employer(s)	2017-05-31	$511,023
2016 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2016 401k financial data
Total income from all sources	2016-05-31	$755,913
Expenses. Total of all expenses incurred	2016-05-31	$755,913
Benefits paid (including direct rollovers)	2016-05-31	$755,913
Value of fidelity bond covering the plan	2016-05-31	$1,000,000
Total contributions received or receivable from participants	2016-05-31	$217,546
Net income (gross income less expenses)	2016-05-31	$0
Total contributions received or receivable from employer(s)	2016-05-31	$538,367
2015 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2015 401k financial data
Total income from all sources	2015-05-31	$659,072
Expenses. Total of all expenses incurred	2015-05-31	$659,072
Benefits paid (including direct rollovers)	2015-05-31	$659,072
Value of fidelity bond covering the plan	2015-05-31	$1,000,000
Total contributions received or receivable from participants	2015-05-31	$310,930
Net income (gross income less expenses)	2015-05-31	$0
Total contributions received or receivable from employer(s)	2015-05-31	$348,142
2014 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2014 401k financial data
Total income from all sources	2014-05-31	$580,235
Expenses. Total of all expenses incurred	2014-05-31	$580,235
Benefits paid (including direct rollovers)	2014-05-31	$580,235
Value of fidelity bond covering the plan	2014-05-31	$1,000,000
Total contributions received or receivable from participants	2014-05-31	$156,312
Net income (gross income less expenses)	2014-05-31	$0
Total contributions received or receivable from employer(s)	2014-05-31	$423,923
2013 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2013 401k financial data
Total income from all sources	2013-05-31	$532,271
Expenses. Total of all expenses incurred	2013-05-31	$532,271
Benefits paid (including direct rollovers)	2013-05-31	$532,271
Value of fidelity bond covering the plan	2013-05-31	$1,000,000
Total contributions received or receivable from participants	2013-05-31	$183,148
Net income (gross income less expenses)	2013-05-31	$0
Total contributions received or receivable from employer(s)	2013-05-31	$349,123
2012 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2012 401k financial data
Total income from all sources	2012-05-31	$558,291
Expenses. Total of all expenses incurred	2012-05-31	$558,291
Benefits paid (including direct rollovers)	2012-05-31	$558,291
Value of fidelity bond covering the plan	2012-05-31	$1,000,000
Total contributions received or receivable from participants	2012-05-31	$213,836
Net income (gross income less expenses)	2012-05-31	$0
Total contributions received or receivable from employer(s)	2012-05-31	$344,455
2011 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2011 401k financial data
Total income from all sources	2011-05-31	$629,741
Expenses. Total of all expenses incurred	2011-05-31	$629,741
Benefits paid (including direct rollovers)	2011-05-31	$629,741
Value of fidelity bond covering the plan	2011-05-31	$1,000,000
Total contributions received or receivable from participants	2011-05-31	$222,022
Net income (gross income less expenses)	2011-05-31	$0
Total contributions received or receivable from employer(s)	2011-05-31	$407,719
2010 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2010 401k financial data
Total income from all sources	2010-05-31	$539,873
Expenses. Total of all expenses incurred	2010-05-31	$539,873
Benefits paid (including direct rollovers)	2010-05-31	$539,873
Value of fidelity bond covering the plan	2010-05-31	$1,000,000
Total contributions received or receivable from participants	2010-05-31	$182,329
Net income (gross income less expenses)	2010-05-31	$0
Total contributions received or receivable from employer(s)	2010-05-31	$357,544
2009 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2009 401k financial data
Total income from all sources	2009-05-31	$647,810
Expenses. Total of all expenses incurred	2009-05-31	$647,810
Benefits paid (including direct rollovers)	2009-05-31	$647,810
Value of fidelity bond covering the plan	2009-05-31	$1,000,000
Total contributions received or receivable from participants	2009-05-31	$143,759
Net income (gross income less expenses)	2009-05-31	$0
Total contributions received or receivable from employer(s)	2009-05-31	$504,051
2008 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2008 401k financial data
Total income from all sources	2008-05-31	$617,759
Expenses. Total of all expenses incurred	2008-05-31	$617,759
Benefits paid (including direct rollovers)	2008-05-31	$617,759
Value of fidelity bond covering the plan	2008-05-31	$1,000,000
Total contributions received or receivable from participants	2008-05-31	$158,592
Net income (gross income less expenses)	2008-05-31	$0
Total contributions received or receivable from employer(s)	2008-05-31	$459,167
2007 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2007 401k financial data
Total income from all sources	2007-05-31	$615,507
Expenses. Total of all expenses incurred	2007-05-31	$615,507
Benefits paid (including direct rollovers)	2007-05-31	$615,507
Value of fidelity bond covering the plan	2007-05-31	$1,000,000
Total contributions received or receivable from participants	2007-05-31	$194,902
Net income (gross income less expenses)	2007-05-31	$0
Total contributions received or receivable from employer(s)	2007-05-31	$420,605
2006 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2006 401k financial data
Total income from all sources	2006-05-31	$600,022
Expenses. Total of all expenses incurred	2006-05-31	$600,022
Benefits paid (including direct rollovers)	2006-05-31	$600,022
Value of fidelity bond covering the plan	2006-05-31	$1,000,000
Total contributions received or receivable from participants	2006-05-31	$186,257
Net income (gross income less expenses)	2006-05-31	$0
Total contributions received or receivable from employer(s)	2006-05-31	$413,765
2005 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2005 401k financial data
Total income from all sources	2005-05-31	$684,014
Expenses. Total of all expenses incurred	2005-05-31	$684,014
Benefits paid (including direct rollovers)	2005-05-31	$684,014
Value of fidelity bond covering the plan	2005-05-31	$750,000
Total contributions received or receivable from participants	2005-05-31	$171,543
Net income (gross income less expenses)	2005-05-31	$0
Total contributions received or receivable from employer(s)	2005-05-31	$512,471
2004 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2004 401k financial data
Total income from all sources	2004-05-31	$657,593
Expenses. Total of all expenses incurred	2004-05-31	$657,593
Benefits paid (including direct rollovers)	2004-05-31	$657,593
Value of fidelity bond covering the plan	2004-05-31	$750,000
Total contributions received or receivable from participants	2004-05-31	$176,436
Net income (gross income less expenses)	2004-05-31	$0
Total contributions received or receivable from employer(s)	2004-05-31	$481,157
2003 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2003 401k financial data
Total income from all sources	2003-05-31	$524,682
Expenses. Total of all expenses incurred	2003-05-31	$524,682
Benefits paid (including direct rollovers)	2003-05-31	$524,682
Value of fidelity bond covering the plan	2003-05-31	$750,000
Total contributions received or receivable from participants	2003-05-31	$123,825
Net income (gross income less expenses)	2003-05-31	$0
Total contributions received or receivable from employer(s)	2003-05-31	$400,857
2002 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2002 401k financial data
Total income from all sources	2002-05-31	$449,453
Expenses. Total of all expenses incurred	2002-05-31	$449,453
Benefits paid (including direct rollovers)	2002-05-31	$449,453
Value of fidelity bond covering the plan	2002-05-31	$750,000
Total contributions received or receivable from participants	2002-05-31	$123,820
Net income (gross income less expenses)	2002-05-31	$0
Total contributions received or receivable from employer(s)	2002-05-31	$325,633
2001 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2001 401k financial data
Total income from all sources	2001-05-31	$384,974
Expenses. Total of all expenses incurred	2001-05-31	$384,974
Benefits paid (including direct rollovers)	2001-05-31	$384,974
Value of fidelity bond covering the plan	2001-05-31	$750,000
Total contributions received or receivable from participants	2001-05-31	$64,748
Net income (gross income less expenses)	2001-05-31	$0
Total contributions received or receivable from employer(s)	2001-05-31	$320,226
2000 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2000 401k financial data
Total income from all sources	2000-05-31	$340,446
Expenses. Total of all expenses incurred	2000-05-31	$340,446
Benefits paid (including direct rollovers)	2000-05-31	$340,446
Value of fidelity bond covering the plan	2000-05-31	$500,000
Total contributions received or receivable from participants	2000-05-31	$33,903
Net income (gross income less expenses)	2000-05-31	$0
Total contributions received or receivable from employer(s)	2000-05-31	$306,543
1999 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1999 401k financial data
Total income from all sources	1999-05-31	$241,695
Expenses. Total of all expenses incurred	1999-05-31	$241,695
Benefits paid (including direct rollovers)	1999-05-31	$241,695
Value of fidelity bond covering the plan	1999-05-31	$500,000
Total contributions received or receivable from participants	1999-05-31	$36,254
Net income (gross income less expenses)	1999-05-31	$0
Total contributions received or receivable from employer(s)	1999-05-31	$205,441
1998 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1998 401k financial data
Total income from all sources	1998-05-31	$190,218
Expenses. Total of all expenses incurred	1998-05-31	$190,218
Benefits paid (including direct rollovers)	1998-05-31	$190,218
Value of fidelity bond covering the plan	1998-05-31	$250,000
Total contributions received or receivable from participants	1998-05-31	$28,533
Net income (gross income less expenses)	1998-05-31	$0
Total contributions received or receivable from employer(s)	1998-05-31	$161,685
1997 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1997 401k financial data
Total income from all sources	1997-05-31	$167,532
Expenses. Total of all expenses incurred	1997-05-31	$167,532
Benefits paid (including direct rollovers)	1997-05-31	$167,532
Value of fidelity bond covering the plan	1997-05-31	$150,000
Total contributions received or receivable from participants	1997-05-31	$25,130
Net income (gross income less expenses)	1997-05-31	$0
Total contributions received or receivable from employer(s)	1997-05-31	$142,402
1996 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1996 401k financial data
Total income from all sources	1996-05-31	$126,772
Expenses. Total of all expenses incurred	1996-05-31	$126,772
Benefits paid (including direct rollovers)	1996-05-31	$126,772
Value of fidelity bond covering the plan	1996-05-31	$100,000
Total contributions received or receivable from participants	1996-05-31	$19,016
Net income (gross income less expenses)	1996-05-31	$0
Total contributions received or receivable from employer(s)	1996-05-31	$107,756
1995 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1995 401k financial data
Total income from all sources	1995-05-31	$131,170
Expenses. Total of all expenses incurred	1995-05-31	$131,170
Benefits paid (including direct rollovers)	1995-05-31	$131,170
Value of fidelity bond covering the plan	1995-05-31	$100,000
Total contributions received or receivable from participants	1995-05-31	$19,675
Net income (gross income less expenses)	1995-05-31	$0
Total contributions received or receivable from employer(s)	1995-05-31	$111,495
1994 : WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1994 401k financial data
Total income from all sources	1994-05-31	$167,469
Expenses. Total of all expenses incurred	1994-05-31	$167,469
Benefits paid (including direct rollovers)	1994-05-31	$167,469
Value of fidelity bond covering the plan	1994-05-31	$100,000
Total contributions received or receivable from participants	1994-05-31	$25,120
Net income (gross income less expenses)	1994-05-31	$0
Total contributions received or receivable from employer(s)	1994-05-31	$142,349

Form 5500 Responses for WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN

2022: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Submission has been amended	No
2022-06-01	This submission is the final filing	No
2022-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-06-01	Plan is a collectively bargained plan	No
2022-06-01	Plan funding arrangement – Trust	Yes
2022-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2021: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Submission has been amended	No
2021-06-01	This submission is the final filing	No
2021-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-06-01	Plan is a collectively bargained plan	No
2021-06-01	Plan funding arrangement – Trust	Yes
2021-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2020: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Submission has been amended	No
2020-06-01	This submission is the final filing	No
2020-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-06-01	Plan is a collectively bargained plan	No
2020-06-01	Plan funding arrangement – Trust	Yes
2020-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2019: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Submission has been amended	No
2019-06-01	This submission is the final filing	No
2019-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-06-01	Plan is a collectively bargained plan	No
2019-06-01	Plan funding arrangement – Trust	Yes
2019-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Submission has been amended	No
2018-06-01	This submission is the final filing	No
2018-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-06-01	Plan is a collectively bargained plan	No
2018-06-01	Plan funding arrangement – Trust	Yes
2018-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2017: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Submission has been amended	No
2017-06-01	This submission is the final filing	No
2017-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-06-01	Plan is a collectively bargained plan	No
2017-06-01	Plan funding arrangement – Trust	Yes
2017-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2016: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Trust	Yes
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2015: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Trust	Yes
2015-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – Trust	Yes
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Trust	Yes
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	Yes
2012-06-01	Plan funding arrangement – Trust	Yes
2012-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Trust	Yes
2011-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2009: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Plan funding arrangement – Trust	Yes
2009-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes
2008: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2008 form 5500 responses
2008-06-01	Type of plan entity	Single employer plan
2008-06-01	Plan funding arrangement – Trust	Yes
2008-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-06-01	Plan benefit arrangement – Insurance	Yes
2007: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2007 form 5500 responses
2007-06-01	Type of plan entity	Single employer plan
2007-06-01	Plan funding arrangement – Trust	Yes
2007-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-06-01	Plan benefit arrangement – Insurance	Yes
2006: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2006 form 5500 responses
2006-06-01	Type of plan entity	Single employer plan
2006-06-01	Plan funding arrangement – Trust	Yes
2006-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-06-01	Plan benefit arrangement – Insurance	Yes
2005: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2005 form 5500 responses
2005-06-01	Type of plan entity	Single employer plan
2005-06-01	Plan funding arrangement – Trust	Yes
2005-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-06-01	Plan benefit arrangement – Insurance	Yes
2004: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2004 form 5500 responses
2004-06-01	Type of plan entity	Single employer plan
2004-06-01	Plan funding arrangement – Trust	Yes
2004-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-06-01	Plan benefit arrangement – Insurance	Yes
2003: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2003 form 5500 responses
2003-06-01	Type of plan entity	Single employer plan
2003-06-01	Plan funding arrangement – Trust	Yes
2003-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2003-06-01	Plan benefit arrangement – Insurance	Yes
2002: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2002 form 5500 responses
2002-06-01	Type of plan entity	Single employer plan
2002-06-01	Plan funding arrangement – Trust	Yes
2002-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2002-06-01	Plan benefit arrangement – Insurance	Yes
2001: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2001 form 5500 responses
2001-06-01	Type of plan entity	Single employer plan
2001-06-01	Plan funding arrangement – Trust	Yes
2001-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2001-06-01	Plan benefit arrangement – Insurance	Yes
2000: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 2000 form 5500 responses
2000-06-01	Type of plan entity	Single employer plan
2000-06-01	Plan funding arrangement – Trust	Yes
2000-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2000-06-01	Plan benefit arrangement – Insurance	Yes
1999: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1999 form 5500 responses
1999-06-01	Type of plan entity	Single employer plan
1999-06-01	Plan funding arrangement – Trust	Yes
1999-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1999-06-01	Plan benefit arrangement – Insurance	Yes
1998: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1998 form 5500 responses
1998-06-01	Type of plan entity	Single employer plan
1998-06-01	Plan funding arrangement – Trust	Yes
1998-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1998-06-01	Plan benefit arrangement – Insurance	Yes
1997: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1997 form 5500 responses
1997-06-01	Type of plan entity	Single employer plan
1997-06-01	Plan funding arrangement – Trust	Yes
1997-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1997-06-01	Plan benefit arrangement – Insurance	Yes
1996: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1996 form 5500 responses
1996-06-01	Type of plan entity	Single employer plan
1996-06-01	Plan funding arrangement – Trust	Yes
1996-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1996-06-01	Plan benefit arrangement – Insurance	Yes
1995: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1995 form 5500 responses
1995-06-01	Type of plan entity	Single employer plan
1995-06-01	Plan funding arrangement – Trust	Yes
1995-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1995-06-01	Plan benefit arrangement – Insurance	Yes
1994: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1994 form 5500 responses
1994-06-01	Type of plan entity	Single employer plan
1994-06-01	Plan funding arrangement – Trust	Yes
1994-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1994-06-01	Plan benefit arrangement – Insurance	Yes
1993: WESTERN ENGINEERING CONTRACTORS, INC. EMPLOYEE WELFARE BENEFITS PLAN 1993 form 5500 responses
1993-06-01	Type of plan entity	Single employer plan
1993-06-01	Plan funding arrangement – Trust	Yes
1993-06-01	Plan funding arrangement – General assets of the sponsor	Yes
1993-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 103 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $28,187 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $569,927 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $28,187 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 21 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $10,415 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $215,771 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,415 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98776711001
Policy instance	7
Insurance contract or identification number 98776711001 Number of Individuals Covered 87 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $597 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,607 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $597 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 90 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $647 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,875 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $647 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	4
Insurance contract or identification number 1D026256 Number of Individuals Covered 22 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $861 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,609 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $861 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	5
Insurance contract or identification number 1D026255 Number of Individuals Covered 39 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $2,377 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $38,378 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,377 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 16851
Policy instance	6
Insurance contract or identification number 400001000 16851 Number of Individuals Covered 17 Insurance policy start date 2022-06-01 Insurance policy end date 2023-05-31 Total amount of commissions paid to insurance broker USD $1,251 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $12,507 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,251 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 14 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $9,432 Total amount of fees paid to insurance company USD $69 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $156,430 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,432 Amount paid for insurance broker fees 69 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 101 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $25,909 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $518,175 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $25,909 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker NONE Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 88 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $565 Total amount of fees paid to insurance company USD $208 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,216 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $565 Amount paid for insurance broker fees 83 Additional information about fees paid to insurance 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	1D026255
Policy instance	5
Insurance contract or identification number 1D026255 Number of Individuals Covered 36 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $2,337 Total amount of fees paid to insurance company USD $986 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $37,800 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,337 Amount paid for insurance broker fees 406 Additional information about fees paid to insurance 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	400001000 16851
Policy instance	6
Insurance contract or identification number 400001000 16851 Number of Individuals Covered 15 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $1,052 Total amount of fees paid to insurance company USD $536 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $10,517 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,052 Amount paid for insurance broker fees 212 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98776711001
Policy instance	7
Insurance contract or identification number 98776711001 Number of Individuals Covered 77 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $524 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,259 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $524 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker NONE Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	4
Insurance contract or identification number 1D026256 Number of Individuals Covered 20 Insurance policy start date 2021-06-01 Insurance policy end date 2022-05-31 Total amount of commissions paid to insurance broker USD $814 Total amount of fees paid to insurance company USD $210 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,142 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $814 Amount paid for insurance broker fees 90 Additional information about fees paid to insurance 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	1D026256
Policy instance	4
Insurance contract or identification number 1D026256 Number of Individuals Covered 19 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $843 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,432 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $464 Insurance broker organization code? 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 114 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $26,750 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $535,004 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $26,750 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 86 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $544 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,039 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $286 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	5
Insurance contract or identification number 1D026255 Number of Individuals Covered 38 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $2,366 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $39,408 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,464 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 16851
Policy instance	6
Insurance contract or identification number 400001000 16851 Number of Individuals Covered 13 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $1,079 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $10,788 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $623 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98776711001
Policy instance	7
Insurance contract or identification number 98776711001 Number of Individuals Covered 68 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $590 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,970 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $590 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 25 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $9,358 Total amount of fees paid to insurance company USD $204 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $190,249 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,358 Amount paid for insurance broker fees 204 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 91 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $24,334 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $494,907 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $24,334 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 22 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $7,973 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $159,053 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,973 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 100 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $555 Total amount of fees paid to insurance company USD $158 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,104 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $555 Insurance broker organization code? 3 Amount paid for insurance broker fees 158 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	1D026256
Policy instance	4
Insurance contract or identification number 1D026256 Number of Individuals Covered 25 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $924 Total amount of fees paid to insurance company USD $430 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $9,238 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $924 Insurance broker organization code? 3 Amount paid for insurance broker fees 430 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	1D026255
Policy instance	5
Insurance contract or identification number 1D026255 Number of Individuals Covered 41 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $2,484 Total amount of fees paid to insurance company USD $1,601 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $40,391 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,484 Insurance broker organization code? 3 Amount paid for insurance broker fees 1601 Additional information about fees paid to insurance broker BROKER BONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98776711001
Policy instance	7
Insurance contract or identification number 98776711001 Number of Individuals Covered 80 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $468 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,148 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $378 Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 16851
Policy instance	6
Insurance contract or identification number 400001000 16851 Number of Individuals Covered 15 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $977 Total amount of fees paid to insurance company USD $385 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $9,766 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $977 Insurance broker organization code? 3 Amount paid for insurance broker fees 385 Additional information about fees paid to insurance broker BROKER BONUS
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 107 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $24,749 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $494,971 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $24,749 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 37 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $10,993 Total amount of fees paid to insurance company USD $1 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $219,814 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,993 Amount paid for insurance broker fees 1 Additional information about fees paid to insurance broker OTHER NON-MONETARY COMPENSATION Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 92 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $487 Total amount of fees paid to insurance company USD $75 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,633 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $487 Insurance broker organization code? 3 Amount paid for insurance broker fees 75 Additional information about fees paid to insurance broker BROKER-RELATED BONUS Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	4
Insurance contract or identification number 1D026255 Number of Individuals Covered 41 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $2,313 Total amount of fees paid to insurance company USD $426 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $44,693 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,313 Insurance broker organization code? 3 Amount paid for insurance broker fees 426 Additional information about fees paid to insurance broker BROKER-RELATED BONUS Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	5
Insurance contract or identification number 1D026256 Number of Individuals Covered 28 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $1,031 Total amount of fees paid to insurance company USD $140 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $10,312 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,031 Insurance broker organization code? 3 Amount paid for insurance broker fees 140 Additional information about fees paid to insurance broker BROKER-RELATED BONUS Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 16851
Policy instance	6
Insurance contract or identification number 400001000 16851 Number of Individuals Covered 15 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $1,040 Total amount of fees paid to insurance company USD $281 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $10,399 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,040 Insurance broker organization code? 3 Amount paid for insurance broker fees 281 Additional information about fees paid to insurance broker BROKER-RELATED BONUS Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	98776711001
Policy instance	7
Insurance contract or identification number 98776711001 Number of Individuals Covered 74 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $500 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,529 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $255 Insurance broker organization code? 3 Insurance broker name EPIC
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 113 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $22,183 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $443,664 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $22,183 Insurance broker organization code? 3 Insurance broker name JENKINS INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 95 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $577 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $4,228 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $577 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	4
Insurance contract or identification number 1D026255 Number of Individuals Covered 38 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $2,705 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $41,856 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,705 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	5
Insurance contract or identification number 1D026256 Number of Individuals Covered 35 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $1,565 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $15,653 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,565 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	100016851
Policy instance	6
Insurance contract or identification number 100016851 Number of Individuals Covered 22 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $1,583 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $15,824 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,583 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	9877671
Policy instance	7
Insurance contract or identification number 9877671 Number of Individuals Covered 85 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $578 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,218 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $487 Insurance broker organization code? 3 Insurance broker name JAMES C JENKINS INS SERVICE INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 35 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $10,324 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $227,470 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,324 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	9877671
Policy instance	7
Insurance contract or identification number 9877671 Number of Individuals Covered 83 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $531 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,355 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $531 Insurance broker organization code? 4 Insurance broker name JAMES C JENKINS INS SERVICE (EPIC)
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 40 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $11,017 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $220,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,523 Insurance broker organization code? 3 Insurance broker name LEAVITT GROUP, DBA JENKINS INSURANC
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 113 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $18,507 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $370,137 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,507 Insurance broker organization code? 3 Insurance broker name JENKINS INSURANCE GROUP
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	3
Insurance contract or identification number 10175622 Number of Individuals Covered 88 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $410 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $2,981 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $344 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	4
Insurance contract or identification number 1D026255 Number of Individuals Covered 34 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $2,087 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $34,115 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,970 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	5
Insurance contract or identification number 1D026256 Number of Individuals Covered 35 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $1,227 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $12,270 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,007 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	100016851
Policy instance	6
Insurance contract or identification number 100016851 Number of Individuals Covered 28 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $1,730 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $13,875 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,485 Insurance broker organization code? 3 Insurance broker name EDGEWOOD PARTNERS INSURANCE CENTER
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 47 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $10,879 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $204,764 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,879 Insurance broker organization code? 3 Insurance broker name LEAVITT GROUP
STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract number	X9842
Policy instance	3
Insurance contract or identification number X9842 Number of Individuals Covered 2 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $1,015 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $25,375 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,015 Insurance broker organization code? 3 Insurance broker name JENKINS INSURANCE SERVICES INC.
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	2
Insurance contract or identification number 104126 Number of Individuals Covered 92 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $15,104 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $302,086 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,104 Insurance broker organization code? 3 Insurance broker name JENKINS INSURANCE SERVICES INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	9877671
Policy instance	4
Insurance contract or identification number 9877671 Number of Individuals Covered 77 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $460 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,010 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $460 Insurance broker organization code? 3 Insurance broker name JAMES C JENKINS INS SERVICE (EPIC)
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10175622
Policy instance	5
Insurance contract or identification number 10175622 Number of Individuals Covered 77 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $476 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $3,399 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $476 Insurance broker organization code? 3 Insurance broker name JAMES C JENKINS INS SERVICE INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026256
Policy instance	7
Insurance contract or identification number 1D026256 Number of Individuals Covered 30 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $1,183 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $11,833 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,183 Insurance broker organization code? 3 Insurance broker name JAMES C JENKINS INS SERVICE INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1D026255
Policy instance	6
Insurance contract or identification number 1D026255 Number of Individuals Covered 31 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $2,258 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $27,768 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,258 Insurance broker organization code? 3 Insurance broker name JAMES C JENKINS INS SERVICE INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	1
Insurance contract or identification number 297590 Number of Individuals Covered 79 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $4,645 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $65,978 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,015 Insurance broker organization code? 3 Insurance broker name PACIFIC ADVISORS INC
STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract number	X9842
Policy instance	4
Insurance contract or identification number X9842 Number of Individuals Covered 2 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $1,207 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $30,171 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,006 Insurance broker organization code? 3 Insurance broker name JENKINS INSURANCE SERVICES INC.
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	3
Insurance contract or identification number 104126 Number of Individuals Covered 107 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $15,965 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $319,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,965 Insurance broker organization code? 3 Insurance broker name WARREN G BENDER CO
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	2
Insurance contract or identification number 602530 Number of Individuals Covered 36 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $7,347 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $146,987 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,347 Insurance broker organization code? 3 Insurance broker name WARREN G BENDER CO
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	4
Insurance contract or identification number 297590 Number of Individuals Covered 77 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $3,930 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $59,313 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	1
Insurance contract or identification number 104126 Number of Individuals Covered 45 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $14,988 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $299,755 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	602530
Policy instance	3
Insurance contract or identification number 602530 Number of Individuals Covered 25 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $9,874 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $167,888 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	602530
Policy instance	1
Insurance contract or identification number 602530 Number of Individuals Covered 25 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $10,297 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $218,416 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 81 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $4,197 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $67,505 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	4
Insurance contract or identification number 104126 Number of Individuals Covered 40 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $15,531 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $310,612 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	602530
Policy instance	3
Insurance contract or identification number 602530 Number of Individuals Covered 18 Insurance policy start date 2009-06-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $9,989 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $203,340 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,989 Insurance broker name MITTERHOLZER & ASSOCIATES INS. SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	4
Insurance contract or identification number 297590 Number of Individuals Covered 72 Insurance policy start date 2009-06-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $3,426 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $56,617 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,359 Insurance broker name WALTER CARDINET
WESTERN HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 6411 )
Policy contract number	104126
Policy instance	1
Insurance contract or identification number 104126 Number of Individuals Covered 33 Insurance policy start date 2009-06-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $12,831 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $256,624 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,831 Insurance broker name WARREN G. BENDER CO.
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	526613
Policy instance	1
Insurance contract or identification number 526613 Number of Individuals Covered 34 Insurance policy start date 2008-06-01 Insurance policy end date 2009-05-31 Total amount of commissions paid to insurance broker USD $10,685 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $213,690 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,685 Insurance broker name MITTERHOLZER & ASSOCIATES INS. SVCS
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	602530
Policy instance	3
Insurance contract or identification number 602530 Number of Individuals Covered 41 Insurance policy start date 2008-06-01 Insurance policy end date 2009-05-31 Total amount of commissions paid to insurance broker USD $11,439 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $328,012 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,439 Insurance broker name MITTERHOLZER & ASSOCIATES INS. SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	4
Insurance contract or identification number 297590 Number of Individuals Covered 98 Insurance policy start date 2008-06-01 Insurance policy end date 2009-05-31 Total amount of commissions paid to insurance broker USD $3,850 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $75,475 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,775 Insurance broker name WALTER CARDINET
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	526613
Policy instance	1
Insurance contract or identification number 526613 Number of Individuals Covered 34 Insurance policy start date 2007-06-01 Insurance policy end date 2008-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $222,245 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker name MITTERHOLZER & ASSOCIATES INS. SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	4
Insurance contract or identification number 297590 Number of Individuals Covered 98 Insurance policy start date 2007-06-01 Insurance policy end date 2008-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $77,608 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	602530
Policy instance	3
Insurance contract or identification number 602530 Number of Individuals Covered 41 Insurance policy start date 2007-06-01 Insurance policy end date 2008-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $291,688 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker name MITTERHOLZER & ASSOCIATES INS. SVCS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 99 Insurance policy start date 2006-06-01 Insurance policy end date 2007-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $83,271 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 103 Insurance policy start date 2005-06-01 Insurance policy end date 2006-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $80,980 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 118 Insurance policy start date 2004-06-01 Insurance policy end date 2005-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $91,859 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	35759
Policy instance	3
Insurance contract or identification number 35759 Number of Individuals Covered 54 Insurance policy start date 2004-06-01 Insurance policy end date 2005-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $275,997 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	3
Insurance contract or identification number 297590 Number of Individuals Covered 119 Insurance policy start date 2003-06-01 Insurance policy end date 2004-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $93,636 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	35759
Policy instance	2
Insurance contract or identification number 35759 Number of Individuals Covered 60 Insurance policy start date 2003-06-01 Insurance policy end date 2004-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $260,998 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	3
Insurance contract or identification number 297590 Number of Individuals Covered 96 Insurance policy start date 2002-06-01 Insurance policy end date 2003-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Life Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $84,389 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	35759
Policy instance	2
Insurance contract or identification number 35759 Number of Individuals Covered 38 Insurance policy start date 2002-06-01 Insurance policy end date 2003-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $152,752 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	35759
Policy instance	3
Insurance contract or identification number 35759 Number of Individuals Covered 26 Insurance policy start date 2000-07-01 Insurance policy end date 2001-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $87,728 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	35759
Policy instance	2
Insurance contract or identification number 35759 Number of Individuals Covered 26 Insurance policy start date 1999-07-01 Insurance policy end date 2000-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $86,989 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	35759
Policy instance	2
Insurance contract or identification number 35759 Number of Individuals Covered 23 Insurance policy start date 1998-07-01 Insurance policy end date 1999-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $54,203 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	35759
Policy instance	2
Insurance contract or identification number 35759 Number of Individuals Covered 14 Insurance policy start date 1997-07-01 Insurance policy end date 1998-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $25,207 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 52 Insurance policy start date 1996-07-01 Insurance policy end date 1997-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $33,504 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 48 Insurance policy start date 1995-07-01 Insurance policy end date 1996-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,899 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	297590
Policy instance	2
Insurance contract or identification number 297590 Number of Individuals Covered 41 Insurance policy start date 1994-07-01 Insurance policy end date 1995-06-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $18,314 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

Potentially related plans

• WESTERN ENGINEERING COMPANY EES SAVINGS PLAN [EIN = 420733506]
• WESTERN ENGINEERING RESEARCH 401 K PROFIT SHARING PLAN TRUST [EIN = 841436263]
• WESTERN ENGINEERING SUPPLY CO 401(K) PROFIT SHARING PLAN & TRUST [EIN = 943259806]
• WESTERN ENGINEERING CONSTRUCTION AND FACILITIES, INC. 401(K) PLAN [EIN = 273340786]