ANDROSCOGGIN SAVINGS BANK has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ANDROSCOGGIN BANK GROUP BENEFIT PLAN
Measure | Date | Value |
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2022: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 198 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 211 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 3 |
Total of all active and inactive participants | 2022-01-01 | 214 |
2021: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 168 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 5 |
Total of all active and inactive participants | 2021-01-01 | 173 |
2020: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 201 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 198 |
Total of all active and inactive participants | 2020-01-01 | 198 |
2019: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 182 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 206 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 1 |
Total of all active and inactive participants | 2019-01-01 | 210 |
2018: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 194 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 174 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 1 |
Total of all active and inactive participants | 2018-01-01 | 182 |
2017: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 185 |
Number of retired or separated participants receiving benefits | 2017-07-01 | 9 |
Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
Total of all active and inactive participants | 2017-07-01 | 194 |
2016: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-07-01 | 302 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 314 |
Number of retired or separated participants receiving benefits | 2016-07-01 | 20 |
Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 20 |
Total of all active and inactive participants | 2016-07-01 | 354 |
2015: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-07-01 | 289 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 302 |
Number of retired or separated participants receiving benefits | 2015-07-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 4 |
Total of all active and inactive participants | 2015-07-01 | 311 |
2014: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 282 |
Number of retired or separated participants receiving benefits | 2014-07-01 | 7 |
Total of all active and inactive participants | 2014-07-01 | 289 |
2013: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-07-01 | 158 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 158 |
Total of all active and inactive participants | 2013-07-01 | 158 |
2012: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 157 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 158 |
Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
Total of all active and inactive participants | 2012-07-01 | 158 |
2011: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 171 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 149 |
Number of retired or separated participants receiving benefits | 2011-07-01 | 8 |
Total of all active and inactive participants | 2011-07-01 | 157 |
2009: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-07-01 | 178 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 187 |
Number of retired or separated participants receiving benefits | 2009-07-01 | 11 |
Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
Total of all active and inactive participants | 2009-07-01 | 198 |
2022: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2022 form 5500 responses |
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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: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2021 form 5500 responses |
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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: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2020 form 5500 responses |
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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: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2019 form 5500 responses |
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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: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2018 form 5500 responses |
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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: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2017 form 5500 responses |
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2017-07-01 | Type of plan entity | Single employer plan |
2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2017-07-01 | Plan funding arrangement – Insurance | Yes |
2017-07-01 | Plan benefit arrangement – Insurance | Yes |
2016: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2016 form 5500 responses |
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2016-07-01 | Type of plan entity | Single employer plan |
2016-07-01 | Plan funding arrangement – Insurance | Yes |
2016-07-01 | Plan benefit arrangement – Insurance | Yes |
2015: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2015 form 5500 responses |
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2015-07-01 | Type of plan entity | Single employer plan |
2015-07-01 | Plan funding arrangement – Insurance | Yes |
2015-07-01 | Plan benefit arrangement – Insurance | Yes |
2014: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2014 form 5500 responses |
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2014-07-01 | Type of plan entity | Single employer plan |
2014-07-01 | Plan funding arrangement – Insurance | Yes |
2014-07-01 | Plan benefit arrangement – Insurance | Yes |
2013: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2013 form 5500 responses |
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2013-07-01 | Type of plan entity | Single employer plan |
2013-07-01 | Submission has been amended | No |
2013-07-01 | This submission is the final filing | No |
2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-07-01 | Plan is a collectively bargained plan | No |
2013-07-01 | Plan funding arrangement – Insurance | Yes |
2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-07-01 | Plan benefit arrangement – Insurance | Yes |
2012: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2012 form 5500 responses |
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2012-07-01 | Type of plan entity | Single employer plan |
2012-07-01 | Submission has been amended | Yes |
2012-07-01 | This submission is the final filing | No |
2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-07-01 | Plan is a collectively bargained plan | No |
2012-07-01 | Plan funding arrangement – Insurance | Yes |
2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-07-01 | Plan benefit arrangement – Insurance | Yes |
2011: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2011 form 5500 responses |
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2011-07-01 | Type of plan entity | Single employer plan |
2011-07-01 | Submission has been amended | No |
2011-07-01 | This submission is the final filing | No |
2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-07-01 | Plan is a collectively bargained plan | No |
2011-07-01 | Plan funding arrangement – Insurance | Yes |
2011-07-01 | Plan benefit arrangement – Insurance | Yes |
2009: ANDROSCOGGIN BANK GROUP BENEFIT PLAN 2009 form 5500 responses |
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2009-07-01 | Type of plan entity | Single employer plan |
2009-07-01 | Submission has been amended | No |
2009-07-01 | This submission is the final filing | No |
2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-07-01 | Plan is a collectively bargained plan | No |
2009-07-01 | Plan funding arrangement – Insurance | Yes |
2009-07-01 | Plan benefit arrangement – Insurance | Yes |
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 112132 |
Policy instance | 8 |
Insurance contract or identification number | 112132 | Number of Individuals Covered | 24 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,051 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $99,717 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,051 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30093553 |
Policy instance | 1 |
Insurance contract or identification number | 30093553 | Number of Individuals Covered | 162 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,467 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,467 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 956067 |
Policy instance | 2 |
Insurance contract or identification number | 956067 | Number of Individuals Covered | 211 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $10,667 | Total amount of fees paid to insurance company | USD $4,268 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $138,387 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,667 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4268 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 956068 |
Policy instance | 3 |
Insurance contract or identification number | 956068 | Number of Individuals Covered | 128 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $8,910 | Total amount of fees paid to insurance company | USD $1,786 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $59,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,910 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1786 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0791491 |
Policy instance | 4 |
Insurance contract or identification number | R0791491 | Number of Individuals Covered | 71 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,020 | Total amount of fees paid to insurance company | USD $2 | Other welfare benefits provided | CRITICAL ILLNESS & ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $25,949 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,211 | Amount paid for insurance broker fees | 1 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 112129 |
Policy instance | 5 |
Insurance contract or identification number | 112129 | Number of Individuals Covered | 254 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $36,074 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,179,501 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,074 | Insurance broker organization code? | 3 |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 112130 |
Policy instance | 6 |
Insurance contract or identification number | 112130 | Number of Individuals Covered | 51 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $5,237 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $183,168 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,237 | Insurance broker organization code? | 3 |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 112131 |
Policy instance | 7 |
Insurance contract or identification number | 112131 | Number of Individuals Covered | 90 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $14,714 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $491,259 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,714 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0791491 |
Policy instance | 5 |
Insurance contract or identification number | R0791491 | Number of Individuals Covered | 79 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,335 | Total amount of fees paid to insurance company | USD $82 | Other welfare benefits provided | CRITICAL ILLNESS & ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $24,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,001 | Amount paid for insurance broker fees | 47 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 956068 |
Policy instance | 4 |
Insurance contract or identification number | 956068 | Number of Individuals Covered | 121 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $7,585 | Total amount of fees paid to insurance company | USD $2,462 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $49,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,585 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2462 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 956067 |
Policy instance | 3 |
Insurance contract or identification number | 956067 | Number of Individuals Covered | 193 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $10,917 | Total amount of fees paid to insurance company | USD $6,417 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $128,334 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,917 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 6417 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30093553 |
Policy instance | 2 |
Insurance contract or identification number | 30093553 | Number of Individuals Covered | 151 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,079 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,079 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0619960 |
Policy instance | 1 |
Insurance contract or identification number | 0619960 | Number of Individuals Covered | 384 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $47,091 | Total amount of fees paid to insurance company | USD $5,700 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,581,895 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $47,091 | Amount paid for insurance broker fees | 5700 | Additional information about fees paid to insurance broker | MEDICAL RETENTION INCENTIVE RISK | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0791491 |
Policy instance | 4 |
Insurance contract or identification number | R0791491 | Number of Individuals Covered | 96 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $17,955 | Total amount of fees paid to insurance company | USD $860 | Other welfare benefits provided | ACCIDENT & CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $27,597 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,773 | Amount paid for insurance broker fees | 496 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00005878 |
Policy instance | 3 |
Insurance contract or identification number | AL00005878 | Number of Individuals Covered | 194 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $21,504 | Total amount of fees paid to insurance company | USD $1,486 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D AND EAP | Welfare Benefit Premiums Paid to Carrier | USD $158,371 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,504 | Amount paid for insurance broker fees | 1486 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30093553 |
Policy instance | 2 |
Insurance contract or identification number | 30093553 | Number of Individuals Covered | 142 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,033 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,936 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,033 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0619960 |
Policy instance | 1 |
Insurance contract or identification number | 0619960 | Number of Individuals Covered | 387 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $45,448 | Total amount of fees paid to insurance company | USD $3,820 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,523,642 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $45,448 | Amount paid for insurance broker fees | 3820 | Additional information about fees paid to insurance broker | MEDICAL RETENTION RISK | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0619960 |
Policy instance | 1 |
Insurance contract or identification number | 0619960 | Number of Individuals Covered | 377 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $40,147 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,333,871 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,478 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30026008 |
Policy instance | 2 |
Insurance contract or identification number | 30026008 | Number of Individuals Covered | 0 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $646 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $646 | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00005878 |
Policy instance | 3 |
Insurance contract or identification number | AL00005878 | Number of Individuals Covered | 196 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $23,814 | Total amount of fees paid to insurance company | USD $4,950 | 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 $146,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,814 | Amount paid for insurance broker fees | 4950 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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ANTHEM HEALTH PLANS OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 52618 ) |
Policy contract number | 00C129 |
Policy instance | 4 |
Insurance contract or identification number | 00C129 | Number of Individuals Covered | 135 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,421 | Total amount of fees paid to insurance company | USD $3,750 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,421 | Amount paid for insurance broker fees | 3750 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00005878 |
Policy instance | 3 |
Insurance contract or identification number | AL00005878 | Number of Individuals Covered | 188 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $17,246 | Total amount of fees paid to insurance company | USD $7,437 | 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 $141,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,595 | Amount paid for insurance broker fees | 7437 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30026008 |
Policy instance | 2 |
Insurance contract or identification number | 30026008 | Number of Individuals Covered | 122 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,005 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0619960 |
Policy instance | 1 |
Insurance contract or identification number | 0619960 | Number of Individuals Covered | 343 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $42,356 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,328,067 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,356 | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00005878 |
Policy instance | 3 |
Insurance contract or identification number | AL00005878 | Number of Individuals Covered | 185 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $9,361 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $64,150 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,361 | Insurance broker organization code? | 3 | Insurance broker name | HOLDEN AGENCY |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30026008 |
Policy instance | 2 |
Insurance contract or identification number | 30026008 | Number of Individuals Covered | 112 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $623 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,466 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $623 | Insurance broker organization code? | 3 | Insurance broker name | HOLDEN AGENCY |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0619960 |
Policy instance | 1 |
Insurance contract or identification number | 0619960 | Number of Individuals Covered | 329 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $16,633 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $654,149 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,633 | Insurance broker organization code? | 3 | Insurance broker name | HOLDEN AGENCY |
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