401k Plan data: ACORN ENGINEERING COMPANY, INC. plan

ACORN ENGINEERING COMPANY, INC. 401k Plan overview

Plan Name	ACORN ENGINEERING COMPANY, INC.
Plan identification number	501

ACORN ENGINEERING COMPANY, INC. Benefits

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

401k Sponsoring company profile

ACORN ENGINEERING COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: ACORN ENGINEERING COMPANY, INC.

Employer identification number (EIN): 951864304

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACORN ENGINEERING COMPANY, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01 ANN LUONG 2021-09-27
501 2019-01-01
501 2018-01-01
501 2017-01-01 ANN LUONG
501 2016-01-01 ANN LUONG
501 2015-01-01 ANN LUONG
501 2014-01-01 ANN LUONG
501 2013-01-01 ANN LUONG
501 2012-01-01 ANN LUONG
501 2011-01-01 ANN LUONG
501 2009-01-01 ANN LUONG
501 2008-01-01

Plan Statistics for ACORN ENGINEERING COMPANY, INC.

401k plan membership statisitcs for ACORN ENGINEERING COMPANY, INC.

Measure Date Value
2022: ACORN ENGINEERING COMPANY, INC. 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,744
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,824
Total of all active and inactive participants 2022-01-01 1,824
2021: ACORN ENGINEERING COMPANY, INC. 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,735
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,744
Total of all active and inactive participants 2021-01-01 1,744
2020: ACORN ENGINEERING COMPANY, INC. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,821
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,735
Total of all active and inactive participants 2020-01-01 1,735
2019: ACORN ENGINEERING COMPANY, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,815
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,821
Total of all active and inactive participants 2019-01-01 1,821
Total participants 2019-01-01 1,821
Number of employers contributing to the scheme 2019-01-01 0
2018: ACORN ENGINEERING COMPANY, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,601
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,815
Total of all active and inactive participants 2018-01-01 1,815
Total participants 2018-01-01 1,815
Number of employers contributing to the scheme 2018-01-01 0
2017: ACORN ENGINEERING COMPANY, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,739
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,601
Total of all active and inactive participants 2017-01-01 1,601
Total participants 2017-01-01 1,601
Number of employers contributing to the scheme 2017-01-01 0
2016: ACORN ENGINEERING COMPANY, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,215
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,739
Total of all active and inactive participants 2016-01-01 1,739
Total participants 2016-01-01 1,739
Number of employers contributing to the scheme 2016-01-01 0
2015: ACORN ENGINEERING COMPANY, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 886
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,215
Total of all active and inactive participants 2015-01-01 1,215
Total participants 2015-01-01 0
Number of employers contributing to the scheme 2015-01-01 0
2014: ACORN ENGINEERING COMPANY, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 897
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 886
Total of all active and inactive participants 2014-01-01 886
Total participants 2014-01-01 0
Number of employers contributing to the scheme 2014-01-01 0
2013: ACORN ENGINEERING COMPANY, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 868
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 897
Total of all active and inactive participants 2013-01-01 897
Total participants 2013-01-01 0
2012: ACORN ENGINEERING COMPANY, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 896
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 868
Total of all active and inactive participants 2012-01-01 868
Total participants 2012-01-01 0
2011: ACORN ENGINEERING COMPANY, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 842
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 896
Total of all active and inactive participants 2011-01-01 896
Total participants 2011-01-01 896
2009: ACORN ENGINEERING COMPANY, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 458
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 867
Total of all active and inactive participants 2009-01-01 867
Total participants 2009-01-01 867

Measure	Date	Value
2022: ACORN ENGINEERING COMPANY, INC. 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,744
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,824
Total of all active and inactive participants	2022-01-01	1,824
2021: ACORN ENGINEERING COMPANY, INC. 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,735
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,744
Total of all active and inactive participants	2021-01-01	1,744
2020: ACORN ENGINEERING COMPANY, INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,821
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,735
Total of all active and inactive participants	2020-01-01	1,735
2019: ACORN ENGINEERING COMPANY, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,815
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,821
Total of all active and inactive participants	2019-01-01	1,821
Total participants	2019-01-01	1,821
Number of employers contributing to the scheme	2019-01-01	0
2018: ACORN ENGINEERING COMPANY, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,601
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,815
Total of all active and inactive participants	2018-01-01	1,815
Total participants	2018-01-01	1,815
Number of employers contributing to the scheme	2018-01-01	0
2017: ACORN ENGINEERING COMPANY, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,739
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,601
Total of all active and inactive participants	2017-01-01	1,601
Total participants	2017-01-01	1,601
Number of employers contributing to the scheme	2017-01-01	0
2016: ACORN ENGINEERING COMPANY, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,215
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,739
Total of all active and inactive participants	2016-01-01	1,739
Total participants	2016-01-01	1,739
Number of employers contributing to the scheme	2016-01-01	0
2015: ACORN ENGINEERING COMPANY, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	886
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,215
Total of all active and inactive participants	2015-01-01	1,215
Total participants	2015-01-01	0
Number of employers contributing to the scheme	2015-01-01	0
2014: ACORN ENGINEERING COMPANY, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	897
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	886
Total of all active and inactive participants	2014-01-01	886
Total participants	2014-01-01	0
Number of employers contributing to the scheme	2014-01-01	0
2013: ACORN ENGINEERING COMPANY, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	868
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	897
Total of all active and inactive participants	2013-01-01	897
Total participants	2013-01-01	0
2012: ACORN ENGINEERING COMPANY, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	896
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	868
Total of all active and inactive participants	2012-01-01	868
Total participants	2012-01-01	0
2011: ACORN ENGINEERING COMPANY, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	842
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	896
Total of all active and inactive participants	2011-01-01	896
Total participants	2011-01-01	896
2009: ACORN ENGINEERING COMPANY, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	458
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	867
Total of all active and inactive participants	2009-01-01	867
Total participants	2009-01-01	867

Financial Data on ACORN ENGINEERING COMPANY, INC.

Measure	Date	Value
2017 : ACORN ENGINEERING COMPANY, INC. 2017 401k financial data
Value of total assets at end of year	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	No
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in common/collective trusts at end of year	2017-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No

Form 5500 Responses for ACORN ENGINEERING COMPANY, INC.

2022: ACORN ENGINEERING COMPANY, INC. 2022 form 5500 responses
2022-01-01	Type of plan entity	Multi-employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ACORN ENGINEERING COMPANY, INC. 2021 form 5500 responses
2021-01-01	Type of plan entity	Multi-employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ACORN ENGINEERING COMPANY, INC. 2020 form 5500 responses
2020-01-01	Type of plan entity	Multi-employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ACORN ENGINEERING COMPANY, INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: ACORN ENGINEERING COMPANY, INC. 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ACORN ENGINEERING COMPANY, INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ACORN ENGINEERING COMPANY, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ACORN ENGINEERING COMPANY, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ACORN ENGINEERING COMPANY, INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ACORN ENGINEERING COMPANY, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ACORN ENGINEERING COMPANY, INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ACORN ENGINEERING COMPANY, INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: ACORN ENGINEERING COMPANY, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: ACORN ENGINEERING COMPANY, INC. 2008 form 5500 responses
2008-01-01	Type of plan entity	Mulitple employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

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

Policy contract number

233336

Policy instance

Insurance contract or identification number	233336
Number of Individuals Covered	61
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $433,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $852
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
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

Policy instance

Number of Individuals Covered	228
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,661,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BNSJ

Policy instance

Insurance contract or identification number	GLTD0BNSJ
Number of Individuals Covered	66
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,244
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,244
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BNSJ

Policy instance

Insurance contract or identification number	GLUG0BNSJ
Number of Individuals Covered	966
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,741
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,741
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDB0BNSJ

Policy instance

Insurance contract or identification number	GUDB0BNSJ
Number of Individuals Covered	221
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $20,941
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,941
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG0BNSJ

Policy instance

Insurance contract or identification number	GUG0BNSJ
Number of Individuals Covered	210
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,034
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,034
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BNSJ

Policy instance

Insurance contract or identification number	GVTL0BNSJ
Number of Individuals Covered	69
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,590
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,590
Insurance broker organization code?	3

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	3
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $30
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

Policy instance

Number of Individuals Covered	248
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,891,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BNSJ

Policy instance

Insurance contract or identification number	GLTD0BNSJ
Number of Individuals Covered	65
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,587
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,587
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BNSJ

Policy instance

Insurance contract or identification number	GLUG0BNSJ
Number of Individuals Covered	937
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,458
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,458
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDB0BNSJ

Policy instance

Insurance contract or identification number	GUDB0BNSJ
Number of Individuals Covered	220
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $20,959
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,959
Additional information about fees paid to insurance broker	AGENT OR BROKER OF ROCORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BNSJ

Policy instance

Insurance contract or identification number	GVTL0BNSJ
Number of Individuals Covered	78
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,995
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,995
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG0BNSJ

Policy instance

Insurance contract or identification number	GUG0BNSJ
Number of Individuals Covered	193
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,951
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,951
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0BNSJ

Policy instance

Insurance contract or identification number	GLTD0BNSJ
Number of Individuals Covered	70
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,664
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,664
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $95
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BNSJ

Policy instance

Insurance contract or identification number	GVTL0BNSJ
Number of Individuals Covered	67
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,486
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,486
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BNSJ

Policy instance

Insurance contract or identification number	GLUG0BNSJ
Number of Individuals Covered	924
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,581
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,581
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDB0BNSJ

Policy instance

Insurance contract or identification number	GUDB0BNSJ
Number of Individuals Covered	198
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $19,417
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,417
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG0BNSJ

Policy instance

Insurance contract or identification number	GUG0BNSJ
Number of Individuals Covered	198
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,036
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,036
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

Policy instance

Number of Individuals Covered	274
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,003,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	4
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $94
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

Policy instance

Number of Individuals Covered	310
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,113,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

0040D033276

Policy instance

Insurance contract or identification number	0040D033276
Number of Individuals Covered	146
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,662
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,662
Insurance broker organization code?	3

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

Policy contract number

000010222266

Policy instance

Insurance contract or identification number	000010222266
Number of Individuals Covered	197
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,771
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,771
Insurance broker organization code?	3

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

Policy contract number

000010222264

Policy instance

Insurance contract or identification number	000010222264
Number of Individuals Covered	1029
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,875
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,875
Insurance broker organization code?	3

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

Policy contract number

00001D033583

Policy instance

Insurance contract or identification number	00001D033583
Number of Individuals Covered	135
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,131
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,131
Insurance broker organization code?	3

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	6
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $99
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	50
Insurance broker organization code?	3

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

Policy instance

Number of Individuals Covered	316
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,950,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

0040D033276

Policy instance

Insurance contract or identification number	0040D033276
Number of Individuals Covered	168
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,894
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,894
Insurance broker organization code?	3

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

Policy contract number

000010222266

Policy instance

Insurance contract or identification number	000010222266
Number of Individuals Covered	190
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,773
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,773

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

Policy contract number

000010222264

Policy instance

Insurance contract or identification number	000010222264
Number of Individuals Covered	988
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,772
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,772
Insurance broker organization code?	3

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

Policy contract number

00001D033583

Policy instance

Insurance contract or identification number	00001D033583
Number of Individuals Covered	147
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,143
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,143
Insurance broker organization code?	3

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

Policy contract number

000010222264

Policy instance

Insurance contract or identification number	000010222264
Number of Individuals Covered	943
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,347
Total amount of fees paid to insurance company	USD $3,022
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,347
Amount paid for insurance broker fees	3022
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

000010222266

Policy instance

Insurance contract or identification number	000010222266
Number of Individuals Covered	187
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,707
Total amount of fees paid to insurance company	USD $897
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,707
Amount paid for insurance broker fees	897
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

0040D033276

Policy instance

Insurance contract or identification number	0040D033276
Number of Individuals Covered	161
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,053
Total amount of fees paid to insurance company	USD $1,753
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,053
Amount paid for insurance broker fees	1753
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

HEALTH NET (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	303
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,875,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	7
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $104
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	51
Insurance broker organization code?	3
Insurance broker name	ROBERT ELI WHITNEY

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	140
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,510
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,510
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $126
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56
Insurance broker organization code?	3
Insurance broker name	JIM BARRETT

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

Policy contract number

277578

Policy instance

Insurance contract or identification number	277578
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	331
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,387
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,387
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	1215
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,113
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,113
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	886
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,630
Total amount of fees paid to insurance company	USD $2,215
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,630
Amount paid for insurance broker fees	2215
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	219
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,208
Total amount of fees paid to insurance company	USD $7,814
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,208
Amount paid for insurance broker fees	7814
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $118
Total amount of fees paid to insurance company	USD $11
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Insurance broker organization code?	3
Amount paid for insurance broker fees	11
Insurance broker name	JIM BARRETT

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

Policy contract number

277578

Policy instance

Insurance contract or identification number	277578
Number of Individuals Covered	364
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,409,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	339
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $19,106
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,106
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $120
Total amount of fees paid to insurance company	USD $4
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53
Insurance broker organization code?	3
Amount paid for insurance broker fees	4
Insurance broker name	JIM BARRETT

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

Policy contract number

277578

Policy instance

Insurance contract or identification number	277578
Number of Individuals Covered	373
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,191,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY 3 (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	365
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $19,112
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,112
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	238
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,418
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,418
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	897
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,738
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,738
Insurance broker organization code?	3
Insurance broker name	BOTTOM LINE INSURANCE SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	868
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,450
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $354
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	260
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,371
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,371
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $111
Total amount of fees paid to insurance company	USD $3
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19
Insurance broker organization code?	3
Amount paid for insurance broker fees	3
Insurance broker name	BENJAMIN MOSQUEDA

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

S0651A, L6641A

Policy instance

Insurance contract or identification number	S0651A, L6641A
Number of Individuals Covered	390
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $-32
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,294,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-32
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	359
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-13
Total amount of commissions paid to insurance broker	USD $18,076
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $180,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,076
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	896
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,788
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	134
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,013
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $118
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	213
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,916
Total amount of fees paid to insurance company	USD $2,520
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $169,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

S0651A, L6641A

Policy instance

Insurance contract or identification number	S0651A, L6641A
Number of Individuals Covered	412
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $49,648
Total amount of fees paid to insurance company	USD $8,130
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,506,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34566

Policy instance

Insurance contract or identification number	H34566
Number of Individuals Covered	650
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,525
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $627
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H33454

Policy instance

Insurance contract or identification number	H33454
Number of Individuals Covered	140
Insurance policy start date	2010-01-10
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,105
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,525
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

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

Policy contract number

3331143

Policy instance

Insurance contract or identification number	3331143
Number of Individuals Covered	441
Insurance policy start date	2009-11-01
Insurance policy end date	2010-07-31
Total amount of commissions paid to insurance broker	USD $125
Total amount of fees paid to insurance company	USD $4,016
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125
Amount paid for insurance broker fees	4016
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

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

Policy contract number

E7083025

Policy instance

Insurance contract or identification number	E7083025
Number of Individuals Covered	8
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $118
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21
Insurance broker organization code?	3
Insurance broker name	BENJAMIN MOSQUEDA

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014174

Policy instance

Insurance contract or identification number	1014174
Number of Individuals Covered	217
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,774
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,774
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )

Policy contract number

S0651A, L6641A

Policy instance

Insurance contract or identification number	S0651A, L6641A
Number of Individuals Covered	435
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,339
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $428,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,339
Insurance broker organization code?	3
Insurance broker name	ANTHONY M HUSTLER

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

H55334, 55045,

Policy instance

Insurance contract or identification number	H55334, 55045,
Number of Individuals Covered	842
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $51,933
Total amount of fees paid to insurance company	USD $233
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,369,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	177
Additional information about fees paid to insurance broker	MISCELLANEOUS GIFTS, MEALS, ENTERTAINMENT ALLOCATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $22,705
Insurance broker name	ANTHONY M HUSTLER

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Company Name:	ACORN ENGINEERING COMPANY, INC.
Employer identification number (EIN):	951864304
NAIC Classification:	332900