PACIFIC MARKET INTERNATIONAL, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PACIFIC MARKET INTERNATIONAL, LLC
Measure | Date | Value |
---|
2022: PACIFIC MARKET INTERNATIONAL, LLC 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-01-01 | 180 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 0 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 0 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: PACIFIC MARKET INTERNATIONAL, LLC 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-01-01 | 162 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 177 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 177 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: PACIFIC MARKET INTERNATIONAL, LLC 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-01-01 | 120 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 156 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 6 |
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 | 162 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: PACIFIC MARKET INTERNATIONAL, LLC 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-01-01 | 129 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 120 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 120 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: PACIFIC MARKET INTERNATIONAL, LLC 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-01-01 | 205 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 129 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 129 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: PACIFIC MARKET INTERNATIONAL, LLC 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-01-01 | 213 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 205 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 205 |
2016: PACIFIC MARKET INTERNATIONAL, LLC 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-01-01 | 105 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 98 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 98 |
2015: PACIFIC MARKET INTERNATIONAL, LLC 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-01-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 105 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 105 |
2014: PACIFIC MARKET INTERNATIONAL, LLC 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-01-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 116 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 116 |
2022: PACIFIC MARKET INTERNATIONAL, LLC 2022 form 5500 responses |
---|
2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | This submission is the final filing | Yes |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2021: PACIFIC MARKET INTERNATIONAL, LLC 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 benefit arrangement – Insurance | Yes |
2020: PACIFIC MARKET INTERNATIONAL, LLC 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 benefit arrangement – Insurance | Yes |
2019: PACIFIC MARKET INTERNATIONAL, LLC 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 benefit arrangement – Insurance | Yes |
2018: PACIFIC MARKET INTERNATIONAL, LLC 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 benefit arrangement – Insurance | Yes |
2017: PACIFIC MARKET INTERNATIONAL, LLC 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 benefit arrangement – Insurance | Yes |
2016: PACIFIC MARKET INTERNATIONAL, LLC 2016 form 5500 responses |
---|
2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Submission has been amended | No |
2016-01-01 | This submission is the final filing | No |
2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-01-01 | Plan is a collectively bargained plan | No |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2015: PACIFIC MARKET INTERNATIONAL, LLC 2015 form 5500 responses |
---|
2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Submission has been amended | No |
2015-01-01 | This submission is the final filing | No |
2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-01-01 | Plan is a collectively bargained plan | No |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2014: PACIFIC MARKET INTERNATIONAL, LLC 2014 form 5500 responses |
---|
2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | First time form 5500 has been submitted | Yes |
2014-01-01 | Submission has been amended | No |
2014-01-01 | This submission is the final filing | No |
2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-01-01 | Plan is a collectively bargained plan | No |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD611916 |
Policy instance | 4 |
Insurance contract or identification number | SGD611916 | Number of Individuals Covered | 251 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $19,869 | Total amount of fees paid to insurance company | USD $2,913 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $141,625 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $19,869 | Amount paid for insurance broker fees | 2913 | 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 | 628598 |
Policy instance | 3 |
Insurance contract or identification number | 628598 | Number of Individuals Covered | 330 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $40,283 | Total amount of fees paid to insurance company | USD $2,993 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $797,844 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $40,283 | Amount paid for insurance broker fees | 2993 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 452 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $8,515 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $8,515 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | Number of Individuals Covered | 236 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,415 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,878 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,415 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | Number of Individuals Covered | 187 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,195 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,554 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,195 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 351 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $7,538 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,538 | Amount paid for insurance broker fees | 0 | 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 | 628598 |
Policy instance | 3 |
Insurance contract or identification number | 628598 | Number of Individuals Covered | 257 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $37,679 | Total amount of fees paid to insurance company | USD $2,966 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $627,516 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $37,679 | Amount paid for insurance broker fees | 2966 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD611916 |
Policy instance | 4 |
Insurance contract or identification number | SGD611916 | Number of Individuals Covered | 177 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $21,926 | Total amount of fees paid to insurance company | USD $1,791 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $134,154 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,926 | Amount paid for insurance broker fees | 1791 | 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: 65498 ) |
Policy contract number | SGD611916 |
Policy instance | 4 |
Insurance contract or identification number | SGD611916 | Number of Individuals Covered | 156 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $13,097 | Total amount of fees paid to insurance company | USD $2,711 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $82,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,097 | Amount paid for insurance broker fees | 2711 | 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 | 628598 |
Policy instance | 3 |
Insurance contract or identification number | 628598 | Number of Individuals Covered | 223 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $33,338 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $514,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,338 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 298 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,042 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,042 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | Number of Individuals Covered | 157 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,126 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,298 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,126 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10222987 |
Policy instance | 6 |
Insurance contract or identification number | 10222987 | Number of Individuals Covered | 121 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $6,367 | Total amount of fees paid to insurance company | USD $1,875 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $41,149 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,367 | Amount paid for insurance broker fees | 1875 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4053598 |
Policy instance | 5 |
Insurance contract or identification number | 4053598 | Number of Individuals Covered | 7 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $316 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $316 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 649319 |
Policy instance | 4 |
Insurance contract or identification number | 649319 | Number of Individuals Covered | 13 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $5,133 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $107,679 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,133 | Amount paid for insurance broker fees | 0 | 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 | 624645 |
Policy instance | 3 |
Insurance contract or identification number | 624645 | Number of Individuals Covered | 188 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $29,832 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,193,289 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,832 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 262 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $5,566 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,566 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | 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 $1,019 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,005 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,019 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | Number of Individuals Covered | 147 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,103 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,103 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 248 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,019 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,019 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 773433 |
Policy instance | 3 |
Insurance contract or identification number | 773433 | Number of Individuals Covered | 246 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $35,749 | Total amount of fees paid to insurance company | USD $8,637 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,345,563 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,749 | Amount paid for insurance broker fees | 8637 | Additional information about fees paid to insurance broker | 2017 PPP ENGAGEMENT CREDIT MEDICAL RETENTION INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 649319 |
Policy instance | 4 |
Insurance contract or identification number | 649319 | Number of Individuals Covered | 19 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $10,428 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,941 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,428 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4053598 |
Policy instance | 5 |
Insurance contract or identification number | 4053598 | Number of Individuals Covered | 11 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,593 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,593 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10222986 |
Policy instance | 6 |
Insurance contract or identification number | 10222986 | Number of Individuals Covered | 129 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,662 | Total amount of fees paid to insurance company | USD $858 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $42,892 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,662 | Amount paid for insurance broker fees | 858 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10222986 |
Policy instance | 6 |
Insurance contract or identification number | 10222986 | Number of Individuals Covered | 175 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $6,191 | Total amount of fees paid to insurance company | USD $5,568 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $39,161 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,191 | Amount paid for insurance broker fees | 5568 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4053598 |
Policy instance | 5 |
Insurance contract or identification number | 4053598 | Number of Individuals Covered | 39 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 649319 |
Policy instance | 4 |
Insurance contract or identification number | 649319 | Number of Individuals Covered | 58 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $18,252 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $388,169 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,826 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | EVCO INSURANCE SERVICES, INC. |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 773433 |
Policy instance | 3 |
Insurance contract or identification number | 773433 | Number of Individuals Covered | 280 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $34,432 | Total amount of fees paid to insurance company | USD $5,560 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,484,786 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,432 | Amount paid for insurance broker fees | 5560 | Additional information about fees paid to insurance broker | 2016-2017 PPP INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 9158 |
Policy instance | 2 |
Insurance contract or identification number | 9158 | Number of Individuals Covered | 331 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $13,535 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,535 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12196736 |
Policy instance | 1 |
Insurance contract or identification number | 12196736 | Number of Individuals Covered | 204 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,189 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,189 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|