PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA
401k plan membership statisitcs for PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA
| Measure | Date | Value |
|---|
| 2022: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-12-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-12-01 | 270 |
| Total of all active and inactive participants | 2022-12-01 | 270 |
| Total participants, beginning-of-year | 2022-08-01 | 248 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 283 |
| Total of all active and inactive participants | 2022-08-01 | 283 |
| 2021: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 248 |
| Total of all active and inactive participants | 2021-08-01 | 248 |
| 2020: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 259 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 261 |
| Total of all active and inactive participants | 2020-08-01 | 261 |
| 2019: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 355 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 259 |
| Total of all active and inactive participants | 2019-08-01 | 259 |
| 2018: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 350 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 355 |
| Total of all active and inactive participants | 2018-08-01 | 355 |
| 2017: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 351 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 350 |
| Total of all active and inactive participants | 2017-08-01 | 350 |
| 2016: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 357 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 351 |
| Total of all active and inactive participants | 2016-08-01 | 351 |
| 2015: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 357 |
| Total of all active and inactive participants | 2015-08-01 | 357 |
| 2014: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 333 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 363 |
| Total of all active and inactive participants | 2014-08-01 | 363 |
| 2013: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 388 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 333 |
| Total of all active and inactive participants | 2013-08-01 | 333 |
| 2012: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 375 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 363 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 25 |
| Number of other retired or separated participants entitled to future benefits | 2012-08-01 | 0 |
| Total of all active and inactive participants | 2012-08-01 | 388 |
| 2011: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 352 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 23 |
| Number of other retired or separated participants entitled to future benefits | 2011-08-01 | 0 |
| Total of all active and inactive participants | 2011-08-01 | 375 |
| 2010: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-08-01 | 352 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-08-01 | 339 |
| Number of retired or separated participants receiving benefits | 2010-08-01 | 24 |
| Number of other retired or separated participants entitled to future benefits | 2010-08-01 | 0 |
| Total of all active and inactive participants | 2010-08-01 | 363 |
| 2009: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 357 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 330 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 22 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 0 |
| Total of all active and inactive participants | 2009-08-01 | 352 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-08-01 | 0 |
| Total participants | 2009-08-01 | 352 |
| Number of participants with account balances | 2009-08-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-08-01 | 0 |
| 2022: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2022 form 5500 responses |
|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Submission has been amended | No |
| 2012-08-01 | This submission is the final filing | No |
| 2012-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-08-01 | Plan is a collectively bargained plan | No |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Submission has been amended | No |
| 2011-08-01 | This submission is the final filing | No |
| 2011-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-08-01 | Plan is a collectively bargained plan | No |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2010 form 5500 responses |
|---|
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Submission has been amended | No |
| 2010-08-01 | This submission is the final filing | No |
| 2010-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-08-01 | Plan is a collectively bargained plan | No |
| 2010-08-01 | Plan funding arrangement – Insurance | Yes |
| 2010-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: PEPSI-COLA BOTTLING COMPANY OF CENTRAL VIRGINIA 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Submission has been amended | No |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-08-01 | Plan is a collectively bargained plan | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $26,645 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $121,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,912 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 3 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 504 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $70,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 3 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 453 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $26,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 283 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $7,153 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $48,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,880 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2022-08-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,023 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10368951001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10368951001 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10021281001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10021281001 | | Number of Individuals Covered | 406 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $2,927 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,927 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $9,368 | | Total amount of fees paid to insurance company | USD $2,420 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $121,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,368 | | Amount paid for insurance broker fees | 2420 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10021281001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10021281001 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $1,904 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,904 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 3 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $9,740 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $132,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,740 | | Insurance broker organization code? | 3 |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 3 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $12,326 | | Total amount of fees paid to insurance company | USD $1,524 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $170,957 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,326 | | Amount paid for insurance broker fees | 1524 | | Additional information about fees paid to insurance broker | INCENTIVE, EDUCATION, COMMUNICATION AND TRAINING | | Insurance broker organization code? | 3 |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-08-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-08-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 72644 |
| Policy instance | 3 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $8,234 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $149,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,234 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 632449 |
| Policy instance | 3 |
| Insurance contract or identification number | 632449 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-08-01 | | Total amount of commissions paid to insurance broker | USD $5,769 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $58,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 72644 |
| Policy instance | 2 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-08-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 72644 |
| Policy instance | 1 |
| Insurance contract or identification number | 72644 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-08-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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