C.H. GUENTHER & SON, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC
401k plan membership statisitcs for GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC
| Measure | Date | Value |
|---|
| 2023: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 2,100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 2,190 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 21 |
| 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 | 2,211 |
| 2022: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,427 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 2,092 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 10 |
| 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 | 2,102 |
| 2021: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,540 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,422 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 8 |
| 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 | 1,430 |
| 2020: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,503 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,528 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 12 |
| 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 | 1,540 |
| 2019: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,354 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,470 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 33 |
| 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 | 1,503 |
| 2018: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,165 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,222 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 132 |
| 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 | 1,354 |
| 2017: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,122 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 6 |
| 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 | 1,128 |
| 2016: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 990 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,125 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 7 |
| 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 | 1,132 |
| 2015: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 982 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 8 |
| 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 | 990 |
| 2014: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,145 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 8 |
| 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 | 1,153 |
| 2013: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 982 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 879 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 10 |
| Total of all active and inactive participants | 2013-01-01 | 889 |
| 2012: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 733 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 982 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 13 |
| Total of all active and inactive participants | 2012-01-01 | 995 |
| 2011: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 755 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 728 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 733 |
| 2009: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 983 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 974 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 769 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 1,743 |
| 2008: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 821 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 771 |
| Number of retired or separated participants receiving benefits | 2008-01-01 | 27 |
| Number of other retired or separated participants entitled to future benefits | 2008-01-01 | 0 |
| Total of all active and inactive participants | 2008-01-01 | 798 |
| 2023: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 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: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: GROUP INSURANCE PLAN FOR C.H. GUENTHER & SON, INC 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | Yes |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | Yes |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | LGS02643-23 |
| Policy instance | 6 |
| Insurance contract or identification number | LGS02643-23 | | Number of Individuals Covered | 1831 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $33,045 | | Total amount of fees paid to insurance company | USD $82,612 | | Welfare Benefit Premiums Paid to Carrier | USD $1,652,231 | | 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 | 801001, 901001 |
| Policy instance | 1 |
| Insurance contract or identification number | 801001, 901001 | | Number of Individuals Covered | 2924 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $297,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 2 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $193,015 | | 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: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 3 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 533 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $11,860 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $79,069 | | 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: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 4 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 544 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $17,400 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $115,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 59767 |
| Policy instance | 5 |
| Insurance contract or identification number | 59767 | | Number of Individuals Covered | 2613 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $49,060 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,122,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342102 |
| Policy instance | 3 |
| Insurance contract or identification number | 3342102 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,384 | | Total amount of fees paid to insurance company | USD $5,912 | | Welfare Benefit Premiums Paid to Carrier | USD $1,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,384 | | Amount paid for insurance broker fees | 5912 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT FEES | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 2 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $183,422 | | 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: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 4 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 476 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $10,566 | | Total amount of fees paid to insurance company | USD $1,340 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $70,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,566 | | Amount paid for insurance broker fees | 1340 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 5 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 479 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,451 | | Total amount of fees paid to insurance company | USD $1,850 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $103,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,451 | | Amount paid for insurance broker fees | 1850 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 59767 |
| Policy instance | 6 |
| Insurance contract or identification number | 59767 | | Number of Individuals Covered | 2530 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $42,573 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $954,422 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,573 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97330801001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 2717 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $222,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| QBE A&H (National Association of Insurance Commissioners NAIC id number: 10219 ) |
| Policy contract number | LGS02643-22 |
| Policy instance | 7 |
| Insurance contract or identification number | LGS02643-22 | | Number of Individuals Covered | 1721 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $29,574 | | Total amount of fees paid to insurance company | USD $73,934 | | Welfare Benefit Premiums Paid to Carrier | USD $1,478,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,574 | | Amount paid for insurance broker fees | 73934 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342102 |
| Policy instance | 3 |
| Insurance contract or identification number | 3342102 | | Number of Individuals Covered | 3079 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $25,937 | | Total amount of fees paid to insurance company | USD $64,468 | | Welfare Benefit Premiums Paid to Carrier | USD $1,405,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,937 | | Amount paid for insurance broker fees | 64468 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT FEES | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 2 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,395 | | 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 | 97330801001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 2606 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $249,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 59767 |
| Policy instance | 6 |
| Insurance contract or identification number | 59767 | | Number of Individuals Covered | 1817 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $14,026 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $792,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,026 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 5 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $18,404 | | Total amount of fees paid to insurance company | USD $1,428 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $116,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,404 | | Amount paid for insurance broker fees | 1428 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 4 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $13,251 | | Total amount of fees paid to insurance company | USD $1,073 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $83,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,251 | | Amount paid for insurance broker fees | 1073 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97330801001 |
| Policy instance | 1 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 2637 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $221,954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 2 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $176,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 59767 |
| Policy instance | 6 |
| Insurance contract or identification number | 59767 | | Number of Individuals Covered | 1903 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $760,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342102 |
| Policy instance | 3 |
| Insurance contract or identification number | 3342102 | | Number of Individuals Covered | 3075 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $29,463 | | Total amount of fees paid to insurance company | USD $73,703 | | Welfare Benefit Premiums Paid to Carrier | USD $1,474,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,463 | | Amount paid for insurance broker fees | 73703 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 4 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,676 | | Total amount of fees paid to insurance company | USD $221 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $55,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,676 | | Amount paid for insurance broker fees | 221 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 5 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $10,227 | | Total amount of fees paid to insurance company | USD $290 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $74,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,227 | | Amount paid for insurance broker fees | 290 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5958512 |
| Policy instance | 11 |
| Insurance contract or identification number | 5958512 | | Number of Individuals Covered | 409 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,428 | | Total amount of fees paid to insurance company | USD $974 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $80,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,428 | | Amount paid for insurance broker fees | 974 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | LK 961148 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961148 | | Number of Individuals Covered | 1478 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $3,838 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $291,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3838 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97330801001 |
| Policy instance | 2 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 2106 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $171,465 | | 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: 64548 ) |
| Policy contract number | FLX965627 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX965627 | | Number of Individuals Covered | 2356 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $4,813 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $355,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4813 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | OK 967210 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 967210 | | Number of Individuals Covered | 1697 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $504 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $36,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 504 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342102 |
| Policy instance | 6 |
| Insurance contract or identification number | 3342102 | | Number of Individuals Covered | 2541 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $71,877 | | Welfare Benefit Premiums Paid to Carrier | USD $1,436,476 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 71877 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT FEES | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 7 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 303 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $6,166 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $41,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,166 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 8 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,849 | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $52,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,849 | | Insurance broker organization code? | 3 |
|
| CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | NYD068404 |
| Policy instance | 9 |
| Insurance contract or identification number | NYD068404 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $36 | | Total amount of fees paid to insurance company | USD $12 | | Other welfare benefits provided | STATUTORY DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36 | | Amount paid for insurance broker fees | 12 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30090494 |
| Policy instance | 10 |
| Insurance contract or identification number | 30090494 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,077 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,077 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 5 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $173,781 | | 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 | 97330801001 |
| Policy instance | 2 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 2057 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,016 | | 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: 64548 ) |
| Policy contract number | LK 961148 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961148 | | Number of Individuals Covered | 1587 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $3,785 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $221,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3785 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | FLX965627 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX965627 | | Number of Individuals Covered | 1816 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $5,640 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $289,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5640 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | OK 967210 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 967210 | | Number of Individuals Covered | 1846 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $554 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $30,187 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 554 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 5 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $146,532 | | 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 | 704633 |
| Policy instance | 6 |
| Insurance contract or identification number | 704633 | | Number of Individuals Covered | 2528 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $20,755 | | Welfare Benefit Premiums Paid to Carrier | USD $1,255,495 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,755 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI 960553 |
| Policy instance | 7 |
| Insurance contract or identification number | AI 960553 | | Number of Individuals Covered | 241 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,959 | | Total amount of fees paid to insurance company | USD $2,054 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $26,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,959 | | Amount paid for insurance broker fees | 2054 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI 960550 |
| Policy instance | 8 |
| Insurance contract or identification number | CI 960550 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,308 | | Total amount of fees paid to insurance company | USD $2,874 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $35,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,308 | | Amount paid for insurance broker fees | 2874 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | FLX965627 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX965627 | | Number of Individuals Covered | 1661 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $5,674 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $321,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5674 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | OK 967210 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 967210 | | Number of Individuals Covered | 1414 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $554 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $31,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 554 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 4689 |
| Policy instance | 5 |
| Insurance contract or identification number | 4689 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $366 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $366 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 704633 |
| Policy instance | 6 |
| Insurance contract or identification number | 704633 | | Number of Individuals Covered | 2385 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $22,219 | | Welfare Benefit Premiums Paid to Carrier | USD $1,109,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,219 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0008707729 |
| Policy instance | 8 |
| Insurance contract or identification number | 0008707729 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $131 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CI, ISWL STND | | Welfare Benefit Premiums Paid to Carrier | USD $3,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 5000002957 |
| Policy instance | 7 |
| Insurance contract or identification number | 5000002957 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $22 | | Total amount of fees paid to insurance company | USD $32 | | Other welfare benefits provided | ILTC | | Welfare Benefit Premiums Paid to Carrier | USD $1,076 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 32 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $22 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | LK 961148 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 961148 | | Number of Individuals Covered | 1087 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $3,949 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $216,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3949 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 97330801001 |
| Policy instance | 2 |
| Insurance contract or identification number | 97330801001 | | Number of Individuals Covered | 1833 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $164,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
