DELTA DENTAL PLAN OF ARKANSAS, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DELTA DENTAL PLAN OF ARKANSAS, INC.
401k plan membership statisitcs for DELTA DENTAL PLAN OF ARKANSAS, INC.
| Measure | Date | Value |
|---|
| 2023: DELTA DENTAL PLAN OF ARKANSAS, INC. 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 234 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 234 |
| 2022: DELTA DENTAL PLAN OF ARKANSAS, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 233 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 233 |
| 2021: DELTA DENTAL PLAN OF ARKANSAS, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 248 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 233 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 233 |
| 2020: DELTA DENTAL PLAN OF ARKANSAS, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 248 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 248 |
| 2019: DELTA DENTAL PLAN OF ARKANSAS, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 233 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 233 |
| 2018: DELTA DENTAL PLAN OF ARKANSAS, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 228 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 228 |
| 2017: DELTA DENTAL PLAN OF ARKANSAS, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 214 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 214 |
| 2016: DELTA DENTAL PLAN OF ARKANSAS, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 193 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 193 |
| 2015: DELTA DENTAL PLAN OF ARKANSAS, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 176 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 176 |
| 2014: DELTA DENTAL PLAN OF ARKANSAS, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 173 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 173 |
| 2013: DELTA DENTAL PLAN OF ARKANSAS, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 168 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 168 |
| Measure | Date | Value |
|---|
| 2015 : DELTA DENTAL PLAN OF ARKANSAS, INC. 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $2,054,165 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $2,054,165 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,952,711 |
| Total plan assets at end of year | 2015-12-31 | $0 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Total contributions received or receivable from participants | 2015-12-31 | $224,358 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $101,454 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $1,829,807 |
| 2014 : DELTA DENTAL PLAN OF ARKANSAS, INC. 2014 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2014-12-31 | $6,752 |
| Total income from all sources | 2014-12-31 | $1,725,842 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,735,283 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,638,613 |
| Total plan assets at end of year | 2014-12-31 | $0 |
| Total plan assets at beginning of year | 2014-12-31 | $16,193 |
| Total contributions received or receivable from participants | 2014-12-31 | $213,117 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $96,670 |
| Net income (gross income less expenses) | 2014-12-31 | $-9,441 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $9,441 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,512,725 |
| 2013 : DELTA DENTAL PLAN OF ARKANSAS, INC. 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $6,752 |
| Total income from all sources | 2013-12-31 | $1,789,524 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $1,780,083 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $1,702,204 |
| Total plan assets at end of year | 2013-12-31 | $16,193 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Total contributions received or receivable from participants | 2013-12-31 | $181,464 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $77,879 |
| Net income (gross income less expenses) | 2013-12-31 | $9,441 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $9,441 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $1,608,060 |
| 2023: DELTA DENTAL PLAN OF ARKANSAS, INC. 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: DELTA DENTAL PLAN OF ARKANSAS, INC. 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: DELTA DENTAL PLAN OF ARKANSAS, INC. 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: DELTA DENTAL PLAN OF ARKANSAS, INC. 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: DELTA DENTAL PLAN OF ARKANSAS, INC. 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: DELTA DENTAL PLAN OF ARKANSAS, INC. 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: DELTA DENTAL PLAN OF ARKANSAS, INC. 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: DELTA DENTAL PLAN OF ARKANSAS, INC. 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: DELTA DENTAL PLAN OF ARKANSAS, INC. 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: DELTA DENTAL PLAN OF ARKANSAS, INC. 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: DELTA DENTAL PLAN OF ARKANSAS, INC. 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 4 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 608 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-020119-00 |
| Policy instance | 3 |
| Insurance contract or identification number | 01-020119-00 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $23,257 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $138,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $154,014 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,378,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) |
| Policy contract number | BTAB-51487-1709 |
| Policy instance | 1 |
| Insurance contract or identification number | BTAB-51487-1709 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $4,050 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 612 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 473 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $140,513 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,900,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,247 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 189 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $30,792 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $174,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,792 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099081363 |
| Policy instance | 4 |
| Insurance contract or identification number | 000099081363 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 620 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $121,096 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,517,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $121,096 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 129 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $26,748 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $151,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,748 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099081363 |
| Policy instance | 4 |
| Insurance contract or identification number | 000099081363 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 630 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 481 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $125,829 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,374,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $125,829 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 224 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $6,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 425344 |
| Policy instance | 4 |
| Insurance contract or identification number | 425344 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,882 | | 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 $132,257 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,882 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099081363 |
| Policy instance | 5 |
| Insurance contract or identification number | 000099081363 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099081363 |
| Policy instance | 5 |
| Insurance contract or identification number | 000099081363 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 425344 |
| Policy instance | 4 |
| Insurance contract or identification number | 425344 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,833 | | 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 $142,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,833 | | Insurance broker organization code? | 3 |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 217 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $5,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 477 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $111,884 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,951,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 111884 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 610 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099081363 |
| Policy instance | 5 |
| Insurance contract or identification number | 000099081363 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 425344 |
| Policy instance | 4 |
| Insurance contract or identification number | 425344 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,483 | | Total amount of fees paid to insurance company | USD $6,208 | | 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 $134,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,483 | | Amount paid for insurance broker fees | 6208 | | Insurance broker organization code? | 3 |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 216 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $6,252 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $106,239 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,179,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 105335 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 576 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 515 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 394 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $87,205 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,658,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 89090 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker name | THE HATCHER AGENCY |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964299 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964299 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,588 | | Total amount of fees paid to insurance company | USD $4,670 | | 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 $131,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,588 | | Amount paid for insurance broker fees | 4670 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH & MCLENNAN AGENCY MCGRAW WENT |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 189 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Other welfare benefits provided | OTHER (EAP) | | Welfare Benefit Premiums Paid to Carrier | USD $5,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099067011 |
| Policy instance | 5 |
| Insurance contract or identification number | 000099067011 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | AON CONSULTING |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 464 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $85,956 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,771,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 85956 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | THE HATCHER AGENCY |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964299 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964299 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 $123,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 169 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | OTHER (EAP) | | Welfare Benefit Premiums Paid to Carrier | USD $5,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000099067011 |
| Policy instance | 5 |
| Insurance contract or identification number | 000099067011 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-06-01 | | Total amount of commissions paid to insurance broker | USD $110 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $110 | | Insurance broker name | AON CONSULTING |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964299 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964299 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 $124,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $-29 | | Total amount of fees paid to insurance company | USD $85,125 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,448,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-29 | | Amount paid for insurance broker fees | 85125 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | THE HATCHER AGENCY |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 469 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX964299 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX964299 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 $116,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 743338 |
| Policy instance | 2 |
| Insurance contract or identification number | 743338 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $75,766 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,520,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75,766 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | THE HATCHER AGENCY |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 ) |
| Policy contract number | 0375 0375V |
| Policy instance | 1 |
| Insurance contract or identification number | 0375 0375V | | Number of Individuals Covered | 468 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
