Civic Intelligence
Filing

CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN

Construction Testing & Engineering, • EIN 93-0997190 • Plan year 2012

Company ProfileSource Archive
Filing Insights

Participants

Down

121 → 101

-20 • -16.53%

Assets

No comparison

- → -

No earlier value available.

Investment Management Fee

-

Admin expenses - • Total expenses -

Filing Details

Context

No event flags were generated for this filing.

Status Flags

Fidelity bond in place

Not reported

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

Not reported

Leases in default

Not reported

Reportable party-in-interest issues

Not reported

Loss discovered during year

Not reported

Assets with undetermined value

Not reported

Non-cash contributions

Not reported

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

Not reported

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

Not reported

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
202210$0$625,640-
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-0$0$625,640-
20211109$5,310,501$805,796$7,393iApproximate average salary by contribution assumption: employee only about $184,816 at 4% or $123,210 at 6%; with 50% employer match about $123,210 at 4% or $82,140 at 6%; with 100% employer match about $92,408 at 4% or $61,605 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-109$5,310,501$805,796$7,393iApproximate average salary by contribution assumption: employee only about $184,816 at 4% or $123,210 at 6%; with 50% employer match about $123,210 at 4% or $82,140 at 6%; with 100% employer match about $92,408 at 4% or $61,605 at 6%.
20201101$5,095,760$911,873$9,028iApproximate average salary by contribution assumption: employee only about $225,711 at 4% or $150,474 at 6%; with 50% employer match about $150,474 at 4% or $100,316 at 6%; with 100% employer match about $112,856 at 4% or $75,237 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-101$5,095,760$911,873$9,028iApproximate average salary by contribution assumption: employee only about $225,711 at 4% or $150,474 at 6%; with 50% employer match about $150,474 at 4% or $100,316 at 6%; with 100% employer match about $112,856 at 4% or $75,237 at 6%.
2019189$5,231,542$1,685,395$18,937iApproximate average salary by contribution assumption: employee only about $473,426 at 4% or $315,617 at 6%; with 50% employer match about $315,617 at 4% or $210,411 at 6%; with 100% employer match about $236,713 at 4% or $157,809 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-89$5,231,542$1,685,395$18,937iApproximate average salary by contribution assumption: employee only about $473,426 at 4% or $315,617 at 6%; with 50% employer match about $315,617 at 4% or $210,411 at 6%; with 100% employer match about $236,713 at 4% or $157,809 at 6%.
2018182$4,498,179$579,064$7,062iApproximate average salary by contribution assumption: employee only about $176,544 at 4% or $117,696 at 6%; with 50% employer match about $117,696 at 4% or $78,464 at 6%; with 100% employer match about $88,272 at 4% or $58,848 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-82$4,498,179$579,064$7,062iApproximate average salary by contribution assumption: employee only about $176,544 at 4% or $117,696 at 6%; with 50% employer match about $117,696 at 4% or $78,464 at 6%; with 100% employer match about $88,272 at 4% or $58,848 at 6%.
2017183$4,881,467$661,507$7,970iApproximate average salary by contribution assumption: employee only about $199,249 at 4% or $132,833 at 6%; with 50% employer match about $132,833 at 4% or $88,555 at 6%; with 100% employer match about $99,625 at 4% or $66,416 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-83$4,881,467$661,507$7,970iApproximate average salary by contribution assumption: employee only about $199,249 at 4% or $132,833 at 6%; with 50% employer match about $132,833 at 4% or $88,555 at 6%; with 100% employer match about $99,625 at 4% or $66,416 at 6%.
2016193$4,552,207$524,274$5,637iApproximate average salary by contribution assumption: employee only about $140,934 at 4% or $93,956 at 6%; with 50% employer match about $93,956 at 4% or $62,637 at 6%; with 100% employer match about $70,467 at 4% or $46,978 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-93$4,552,207$524,274$5,637iApproximate average salary by contribution assumption: employee only about $140,934 at 4% or $93,956 at 6%; with 50% employer match about $93,956 at 4% or $62,637 at 6%; with 100% employer match about $70,467 at 4% or $46,978 at 6%.
2015285$5,038,887$502,926$5,917iApproximate average salary by contribution assumption: employee only about $147,919 at 4% or $98,613 at 6%; with 50% employer match about $98,613 at 4% or $65,742 at 6%; with 100% employer match about $73,960 at 4% or $49,306 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-85$5,038,887$502,926$5,917iApproximate average salary by contribution assumption: employee only about $147,919 at 4% or $98,613 at 6%; with 50% employer match about $98,613 at 4% or $65,742 at 6%; with 100% employer match about $73,960 at 4% or $49,306 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-63---
20142107$6,002,095$625,899$5,850iApproximate average salary by contribution assumption: employee only about $146,238 at 4% or $97,492 at 6%; with 50% employer match about $97,492 at 4% or $64,995 at 6%; with 100% employer match about $73,119 at 4% or $48,746 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-84$6,002,095$625,899$7,451iApproximate average salary by contribution assumption: employee only about $186,279 at 4% or $124,186 at 6%; with 50% employer match about $124,186 at 4% or $82,791 at 6%; with 100% employer match about $93,140 at 4% or $62,093 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-107---
20132124$5,701,920$650,823$5,249iApproximate average salary by contribution assumption: employee only about $131,214 at 4% or $87,476 at 6%; with 50% employer match about $87,476 at 4% or $58,317 at 6%; with 100% employer match about $65,607 at 4% or $43,738 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-124$5,701,920$650,823$5,249iApproximate average salary by contribution assumption: employee only about $131,214 at 4% or $87,476 at 6%; with 50% employer match about $87,476 at 4% or $58,317 at 6%; with 100% employer match about $65,607 at 4% or $43,738 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-101---
20122136$4,986,574$800,445$5,886iApproximate average salary by contribution assumption: employee only about $147,141 at 4% or $98,094 at 6%; with 50% employer match about $98,094 at 4% or $65,396 at 6%; with 100% employer match about $73,570 at 4% or $49,047 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-136$4,986,574$800,445$5,886iApproximate average salary by contribution assumption: employee only about $147,141 at 4% or $98,094 at 6%; with 50% employer match about $98,094 at 4% or $65,396 at 6%; with 100% employer match about $73,570 at 4% or $49,047 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLANCurrent101---
20112153$4,356,911$720,201$4,707iApproximate average salary by contribution assumption: employee only about $117,680 at 4% or $78,453 at 6%; with 50% employer match about $78,453 at 4% or $52,302 at 6%; with 100% employer match about $58,840 at 4% or $39,227 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-153$4,356,911$720,201$4,707iApproximate average salary by contribution assumption: employee only about $117,680 at 4% or $78,453 at 6%; with 50% employer match about $78,453 at 4% or $52,302 at 6%; with 100% employer match about $58,840 at 4% or $39,227 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-121---
20102156$4,397,549$558,890$3,583iApproximate average salary by contribution assumption: employee only about $89,566 at 4% or $59,710 at 6%; with 50% employer match about $59,710 at 4% or $39,807 at 6%; with 100% employer match about $44,783 at 4% or $29,855 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-156$4,397,549$558,890$3,583iApproximate average salary by contribution assumption: employee only about $89,566 at 4% or $59,710 at 6%; with 50% employer match about $59,710 at 4% or $39,807 at 6%; with 100% employer match about $44,783 at 4% or $29,855 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-125---
20092149$3,592,314$597,183$4,008iApproximate average salary by contribution assumption: employee only about $100,198 at 4% or $66,799 at 6%; with 50% employer match about $66,799 at 4% or $44,533 at 6%; with 100% employer match about $50,099 at 4% or $33,399 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-149$3,592,314$597,183$4,008iApproximate average salary by contribution assumption: employee only about $100,198 at 4% or $66,799 at 6%; with 50% employer match about $66,799 at 4% or $44,533 at 6%; with 100% employer match about $50,099 at 4% or $33,399 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-124---
20082166$2,454,149$581,243$3,501iApproximate average salary by contribution assumption: employee only about $87,537 at 4% or $58,358 at 6%; with 50% employer match about $58,358 at 4% or $38,905 at 6%; with 100% employer match about $43,768 at 4% or $29,179 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-166$2,454,149$581,243$3,501iApproximate average salary by contribution assumption: employee only about $87,537 at 4% or $58,358 at 6%; with 50% employer match about $58,358 at 4% or $38,905 at 6%; with 100% employer match about $43,768 at 4% or $29,179 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-161---
20072161$3,589,813$660,356$4,102iApproximate average salary by contribution assumption: employee only about $102,540 at 4% or $68,360 at 6%; with 50% employer match about $68,360 at 4% or $45,573 at 6%; with 100% employer match about $51,270 at 4% or $34,180 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-161$3,589,813$660,356$4,102iApproximate average salary by contribution assumption: employee only about $102,540 at 4% or $68,360 at 6%; with 50% employer match about $68,360 at 4% or $45,573 at 6%; with 100% employer match about $51,270 at 4% or $34,180 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-161---
20062158$2,748,013$561,767$3,555iApproximate average salary by contribution assumption: employee only about $88,887 at 4% or $59,258 at 6%; with 50% employer match about $59,258 at 4% or $39,505 at 6%; with 100% employer match about $44,444 at 4% or $29,629 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-148$2,748,013$561,767$3,796iApproximate average salary by contribution assumption: employee only about $94,893 at 4% or $63,262 at 6%; with 50% employer match about $63,262 at 4% or $42,175 at 6%; with 100% employer match about $47,447 at 4% or $31,631 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-158---
20052156$2,140,638$526,264$3,373iApproximate average salary by contribution assumption: employee only about $84,337 at 4% or $56,225 at 6%; with 50% employer match about $56,225 at 4% or $37,483 at 6%; with 100% employer match about $42,169 at 4% or $28,112 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-156$2,140,638$526,264$3,373iApproximate average salary by contribution assumption: employee only about $84,337 at 4% or $56,225 at 6%; with 50% employer match about $56,225 at 4% or $37,483 at 6%; with 100% employer match about $42,169 at 4% or $28,112 at 6%.
CONSTRUCTION TESTING & ENGINEERING, INC. WELFARE BENEFITS PLAN-138---
20041136$1,604,052$439,717$3,233iApproximate average salary by contribution assumption: employee only about $80,830 at 4% or $53,887 at 6%; with 50% employer match about $53,887 at 4% or $35,925 at 6%; with 100% employer match about $40,415 at 4% or $26,943 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-136$1,604,052$439,717$3,233iApproximate average salary by contribution assumption: employee only about $80,830 at 4% or $53,887 at 6%; with 50% employer match about $53,887 at 4% or $35,925 at 6%; with 100% employer match about $40,415 at 4% or $26,943 at 6%.
2003182$0$0-
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-82---
2002170$682,419$318,096$4,544iApproximate average salary by contribution assumption: employee only about $113,606 at 4% or $75,737 at 6%; with 50% employer match about $75,737 at 4% or $50,491 at 6%; with 100% employer match about $56,803 at 4% or $37,869 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-70$682,419$318,096$4,544iApproximate average salary by contribution assumption: employee only about $113,606 at 4% or $75,737 at 6%; with 50% employer match about $75,737 at 4% or $50,491 at 6%; with 100% employer match about $56,803 at 4% or $37,869 at 6%.
20011168$0$0-
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-168---
20001161$0$0-
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-161---
1999153$443,746$62,769$1,184iApproximate average salary by contribution assumption: employee only about $29,608 at 4% or $19,739 at 6%; with 50% employer match about $19,739 at 4% or $13,159 at 6%; with 100% employer match about $14,804 at 4% or $9,869 at 6%.
Construction Testing & Engineering Inc. 401K Retirement Savings Plan-53$443,746$62,769$1,184iApproximate average salary by contribution assumption: employee only about $29,608 at 4% or $19,739 at 6%; with 50% employer match about $19,739 at 4% or $13,159 at 6%; with 100% employer match about $14,804 at 4% or $9,869 at 6%.
Schedule Details

Schedule A

Row 1
Form Id
4
Ins Broker Name
JOHN BURNHAM INSURANCE SERVICES
Ins Broker US Address1
750 B STREET, SUITE 2400
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92101
Ins Broker Comm Pd Amount
$347
Ins Broker Code
3
Row 2
Form Id
1
Ins Broker Name
JOHN BURNHAM INSURANCE SERVICES
Ins Broker US Address1
750 B STREET, SUITE 2400
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92101
Ins Broker Comm Pd Amount
$499
Ins Broker Code
3
Row 3
Form Id
2
Ins Broker Name
FREDRICK DUANE BRADFORD
Ins Broker US Address1
16057 OAKLEY ROAD
Ins Broker US City
RAMONA
Ins Broker US State
CA
Ins Broker US ZIP
92065
Ins Broker Comm Pd Amount
$877
Ins Broker Code
3
Row 4
Form Id
5
Ins Broker Name
JOHN BURNHAM INSURANCE SERVICES
Ins Broker US Address1
750 B STREET, SUITE 2400
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92101
Ins Broker Comm Pd Amount
$12,298
Ins Broker Code
3
Row 5
Form Id
3
Ins Broker Name
JOHN BURNHAM INSURANCE SERVICES
Ins Broker US Address1
750 B STREET, SUITE 2400
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92101
Ins Broker Comm Pd Amount
$2,540
Ins Broker Fees Pd Amount
$2,976
Ins Broker Fees Pd Text
SALES & SERVICE OVERRIDES
Ins Broker Code
3
Row 6
Form Id
2
Ins Broker Name
MICHAEL JAY MINNEY
Ins Broker US Address1
P.O. BOX 365
Ins Broker US City
POWAY
Ins Broker US State
CA
Ins Broker US ZIP
92074
Ins Broker Comm Pd Amount
$19
Ins Broker Fees Pd Amount
$3
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 7
Form Id
2
Ins Broker Name
JUDITH ANN ALLEY
Ins Broker US Address1
677 S. PENDLETON AVENUE
Ins Broker US City
PENDLETON
Ins Broker US State
IN
Ins Broker US ZIP
46064
Ins Broker Comm Pd Amount
$22
Ins Broker Code
3
Row 8
Form Id
2
Ins Broker Name
UZIEL RIVERA
Ins Broker US Address1
543 CHEROKEE CIRCLE
Ins Broker US City
BANNING
Ins Broker US State
CA
Ins Broker US ZIP
92220
Ins Broker Comm Pd Amount
$15
Ins Broker Fees Pd Amount
$4
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 9
Form Id
2
Ins Broker Name
TERIE BRADFORD
Ins Broker US Address1
16057 OAKLEY ROAD
Ins Broker US City
RAMONA
Ins Broker US State
CA
Ins Broker US ZIP
92065
Ins Broker Comm Pd Amount
$18
Ins Broker Code
3
Row 10
Form Id
2
Ins Broker Name
JIM BARRETT
Ins Broker US Address1
1356 MIRACIELO COURT
Ins Broker US City
SAN MARCOS
Ins Broker US State
CA
Ins Broker US ZIP
92078
Ins Broker Comm Pd Amount
$2
Ins Broker Code
3
Row 11
Form Id
5
Ins Broker Name
GS SCHAFFER INSURANCE SOLUTIONS LLC
Ins Broker US Address1
1831 CRAIGMORE AVENUE
Ins Broker US City
ESCONDIDO
Ins Broker US State
CA
Ins Broker US ZIP
92027
Ins Broker Comm Pd Amount
$24
Ins Broker Code
3
Row 12
Form Id
2
Ins Broker Name
ROGER STUART KENCHEL
Ins Broker US Address1
2530 VISTA WAY
Ins Broker US City
OCEANSIDE
Ins Broker US State
CA
Ins Broker US ZIP
92054
Ins Broker Comm Pd Amount
$197
Ins Broker Fees Pd Amount
$39
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 13
Form Id
3
Ins Broker Name
PACIFIC ADVISORS INC.
Ins Broker US Address1
333 N. INDIAN HILL BLVD.
Ins Broker US City
CLAREMONT
Ins Broker US State
CA
Ins Broker US ZIP
91711
Ins Broker Comm Pd Amount
$50
Ins Broker Code
3
Row 14
Form Id
2
Ins Broker Name
BRIAN AKIAN
Ins Broker US Address1
503 SPRINGBROOK NORTH
Ins Broker US City
IRVINE
Ins Broker US State
CA
Ins Broker US ZIP
92614
Ins Broker Comm Pd Amount
$119
Ins Broker Fees Pd Amount
$48
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 15
Form Id
2
Ins Broker Name
BARNEY & BARNEY LLC
Ins Broker US Address1
P.O. BOX 85638
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92186
Ins Broker Comm Pd Amount
$107
Ins Broker Code
3
Row 16
Form Id
2
Ins Broker Name
JOHN BURNHAM INSURANCE SERVICES
Ins Broker US Address1
19100 VON KARMAN AVENUE
Ins Broker US City
IRVINE
Ins Broker US State
CA
Ins Broker US ZIP
92612
Ins Broker Comm Pd Amount
$105
Ins Broker Code
3
Row 17
Form Id
2
Ins Broker Name
BRUCE WILLIAM BUSSER
Ins Broker US Address1
22461 SAN JOAQUIN DRIVE WEST
Ins Broker US City
CANYON LAKE
Ins Broker US State
CA
Ins Broker US ZIP
92587
Ins Broker Comm Pd Amount
$77
Ins Broker Fees Pd Amount
$24
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 18
Form Id
2
Ins Broker Name
CLIENT BENEFIT INSURANCE SERVICES
Ins Broker US Address1
5675 RUFFIN ROAD
Ins Broker US City
SAN DIEGO
Ins Broker US State
CA
Ins Broker US ZIP
92123
Ins Broker Comm Pd Amount
$37
Ins Broker Fees Pd Amount
$15
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 19
Form Id
2
Ins Broker Name
LORI ANN LAINE
Ins Broker US Address1
28468 CARRIAGE HILL DRIVE
Ins Broker US City
HIGHLAND
Ins Broker US State
CA
Ins Broker US ZIP
92346
Ins Broker Comm Pd Amount
$32
Ins Broker Fees Pd Amount
$7
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 20
Form Id
2
Ins Broker Name
MICHAEL F FAHEY III
Ins Broker US Address1
411 AVENIDA ADOBE
Ins Broker US City
SAN CLEMENTE
Ins Broker US State
CA
Ins Broker US ZIP
92672
Ins Broker Comm Pd Amount
$23
Ins Broker Fees Pd Amount
$7
Ins Broker Fees Pd Text
SERVICE FEE
Ins Broker Code
3
Row 21
Ins Carrier Name: THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
Form Id
4
Schedule A Plan Year Begin Date
2012-09-01
Schedule A Plan Year End Date
2013-08-31
Schedule A Plan Num
501
Schedule A EIN
93-0997190
Ins Carrier Name
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
Ins Carrier EIN
35-0472300
Ins Carrier Naic Code
65676
Ins Contract Num
10101416
Ins Prsn Covered End of year Count
116
Ins Policy From Date
2012-04-01
Ins Policy To Date
2013-03-31
Ins Broker Comm Total Amount
$347
Ins Broker Fees Total Amount
$0
Alloc Contracts Indiv Indicator
No
Alloc Contracts Group Indicator
No
Alloc Contracts Other Indicator
No
Pens Distr Bnft Terminate Pln Indicator
No
Unalloc Contracts Dep Adm Indicator
No
Unal Contrac Imm Part Guar Indicator
No
Unal Contracts Guar Invest Indicator
No
Unalloc Contracts Other Indicator
No
Wlfr Bnft Health Indicator
No
Wlfr Bnft Dental Indicator
No
Wlfr Bnft Vision Indicator
No
Wlfr Bnft Life Insur Indicator
Yes
Wlfr Bnft Temp Disab Indicator
No
Wlfr Bnft Long Terminate Disab Indicator
No
Wlfr Bnft Unemp Indicator
No
Wlfr Bnft Drug Indicator
No
Wlfr Bnft Stop Loss Indicator
No
Wlfr Bnft Hmo Indicator
No
Wlfr Bnft Ppo Indicator
No
Wlfr Bnft Indemnity Indicator
No
Wlfr Bnft Other Indicator
Yes
Wlfr Type Bnft Oth Text
ACCIDENTAL DEATH & DISMEMBERMENT
Wlfr Refund Cash Indicator
No
Wlfr Refund Credit Indicator
No
Wlfr Total Charges Paid Amount
$2,312
Ins Fail Provide Info Indicator
No
Row 22
Ins Carrier Name: GUARDIAN
Form Id
3
Schedule A Plan Year Begin Date
2012-09-01
Schedule A Plan Year End Date
2013-08-31
Schedule A Plan Num
501
Schedule A EIN
93-0997190
Ins Carrier Name
GUARDIAN
Ins Carrier EIN
13-5123390
Ins Carrier Naic Code
64246
Ins Contract Num
00363006
Ins Prsn Covered End of year Count
69
Ins Policy From Date
2012-04-01
Ins Policy To Date
2013-03-31
Ins Broker Comm Total Amount
$2,590
Ins Broker Fees Total Amount
$2,976
Alloc Contracts Indiv Indicator
No
Alloc Contracts Group Indicator
No
Alloc Contracts Other Indicator
No
Pens Distr Bnft Terminate Pln Indicator
No
Unalloc Contracts Dep Adm Indicator
No
Unal Contrac Imm Part Guar Indicator
No
Unal Contracts Guar Invest Indicator
No
Unalloc Contracts Other Indicator
No
Wlfr Bnft Health Indicator
No
Wlfr Bnft Dental Indicator
Yes
Wlfr Bnft Vision Indicator
No
Wlfr Bnft Life Insur Indicator
No
Wlfr Bnft Temp Disab Indicator
No
Wlfr Bnft Long Terminate Disab Indicator
No
Wlfr Bnft Unemp Indicator
No
Wlfr Bnft Drug Indicator
No
Wlfr Bnft Stop Loss Indicator
No
Wlfr Bnft Hmo Indicator
No
Wlfr Bnft Ppo Indicator
No
Wlfr Bnft Indemnity Indicator
No
Wlfr Bnft Other Indicator
No
Wlfr Refund Cash Indicator
No
Wlfr Refund Credit Indicator
No
Wlfr Total Charges Paid Amount
$41,623
Ins Fail Provide Info Indicator
No
Row 23
Ins Carrier Name: COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
Form Id
2
Schedule A Plan Year Begin Date
2012-09-01
Schedule A Plan Year End Date
2013-08-31
Schedule A Plan Num
501
Schedule A EIN
93-0997190
Ins Carrier Name
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
Ins Carrier EIN
57-0144607
Ins Carrier Naic Code
62049
Ins Contract Num
E7074313
Ins Prsn Covered End of year Count
14
Ins Policy From Date
2012-06-01
Ins Policy To Date
2013-05-31
Ins Broker Comm Total Amount
$1,650
Ins Broker Fees Total Amount
$147
Alloc Contracts Indiv Indicator
No
Alloc Contracts Group Indicator
No
Alloc Contracts Other Indicator
No
Pens Distr Bnft Terminate Pln Indicator
No
Unalloc Contracts Dep Adm Indicator
No
Unal Contrac Imm Part Guar Indicator
No
Unal Contracts Guar Invest Indicator
No
Unalloc Contracts Other Indicator
No
Wlfr Bnft Health Indicator
No
Wlfr Bnft Dental Indicator
No
Wlfr Bnft Vision Indicator
No
Wlfr Bnft Life Insur Indicator
Yes
Wlfr Bnft Temp Disab Indicator
Yes
Wlfr Bnft Long Terminate Disab Indicator
No
Wlfr Bnft Unemp Indicator
No
Wlfr Bnft Drug Indicator
No
Wlfr Bnft Stop Loss Indicator
No
Wlfr Bnft Hmo Indicator
No
Wlfr Bnft Ppo Indicator
No
Wlfr Bnft Indemnity Indicator
No
Wlfr Bnft Other Indicator
Yes
Wlfr Type Bnft Oth Text
CANCER, CRITICAL ILLNESS AND HOSPITAL CONFINEMENT
Wlfr Refund Cash Indicator
No
Wlfr Refund Credit Indicator
No
Wlfr Total Charges Paid Amount
$16,549
Ins Fail Provide Info Indicator
No
Row 24
Ins Carrier Name: KAISER PERMANENTE
Form Id
5
Schedule A Plan Year Begin Date
2012-09-01
Schedule A Plan Year End Date
2013-08-31
Schedule A Plan Num
501
Schedule A EIN
93-0997190
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
94-1340523
Ins Carrier Naic Code
00000
Ins Contract Num
225925
Ins Prsn Covered End of year Count
65
Ins Policy From Date
2011-10-01
Ins Policy To Date
2012-09-30
Ins Broker Comm Total Amount
$12,322
Ins Broker Fees Total Amount
$0
Alloc Contracts Indiv Indicator
No
Alloc Contracts Group Indicator
No
Alloc Contracts Other Indicator
No
Pens Distr Bnft Terminate Pln Indicator
No
Unalloc Contracts Dep Adm Indicator
No
Unal Contrac Imm Part Guar Indicator
No
Unal Contracts Guar Invest Indicator
No
Unalloc Contracts Other Indicator
No
Wlfr Bnft Health Indicator
Yes
Wlfr Bnft Dental Indicator
No
Wlfr Bnft Vision Indicator
No
Wlfr Bnft Life Insur Indicator
No
Wlfr Bnft Temp Disab Indicator
No
Wlfr Bnft Long Terminate Disab Indicator
No
Wlfr Bnft Unemp Indicator
No
Wlfr Bnft Drug Indicator
No
Wlfr Bnft Stop Loss Indicator
No
Wlfr Bnft Hmo Indicator
Yes
Wlfr Bnft Ppo Indicator
No
Wlfr Bnft Indemnity Indicator
No
Wlfr Bnft Other Indicator
No
Wlfr Refund Cash Indicator
No
Wlfr Refund Credit Indicator
No
Wlfr Total Charges Paid Amount
$436,944
Ins Fail Provide Info Indicator
No
Row 25
Ins Carrier Name: VISION PLAN OF AMERICA
Form Id
1
Schedule A Plan Year Begin Date
2012-09-01
Schedule A Plan Year End Date
2013-08-31
Schedule A Plan Num
501
Schedule A EIN
93-0997190
Ins Carrier Name
VISION PLAN OF AMERICA
Ins Carrier EIN
95-3998493
Ins Carrier Naic Code
00000
Ins Contract Num
862
Ins Prsn Covered End of year Count
31
Ins Policy From Date
2012-09-01
Ins Policy To Date
2013-08-31
Ins Broker Comm Total Amount
$499
Ins Broker Fees Total Amount
$0
Alloc Contracts Indiv Indicator
No
Alloc Contracts Group Indicator
No
Alloc Contracts Other Indicator
No
Pens Distr Bnft Terminate Pln Indicator
No
Unalloc Contracts Dep Adm Indicator
No
Unal Contrac Imm Part Guar Indicator
No
Unal Contracts Guar Invest Indicator
No
Unalloc Contracts Other Indicator
No
Wlfr Bnft Health Indicator
No
Wlfr Bnft Dental Indicator
No
Wlfr Bnft Vision Indicator
Yes
Wlfr Bnft Life Insur Indicator
No
Wlfr Bnft Temp Disab Indicator
No
Wlfr Bnft Long Terminate Disab Indicator
No
Wlfr Bnft Unemp Indicator
No
Wlfr Bnft Drug Indicator
No
Wlfr Bnft Stop Loss Indicator
No
Wlfr Bnft Hmo Indicator
No
Wlfr Bnft Ppo Indicator
No
Wlfr Bnft Indemnity Indicator
No
Wlfr Bnft Other Indicator
No
Wlfr Refund Cash Indicator
No
Wlfr Refund Credit Indicator
No
Wlfr Total Charges Paid Amount
$3,097
Ins Fail Provide Info Indicator
No

Filing received by DOL Apr 17, 2014