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STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 401k Plan overview

Plan NameSTANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125
Plan identification number 501

STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

STANDARD OIL OF CONNECTICUT, INC. has sponsored the creation of one or more 401k plans.

Company Name:STANDARD OIL OF CONNECTICUT, INC.
Employer identification number (EIN):060665104
NAIC Classification:424700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01RAMY PERESS RAMY PERESS2018-07-18
5012016-01-01RAMY PERESS RAMY PERESS2017-07-27
5012015-01-01RAMY PERESS RAMY PERESS2016-07-19
5012014-01-01RAMY PERESS RAMY PERESS2015-07-20
5012013-01-01RAMY PERESS RAMY PERESS2014-07-11
5012012-01-01RAMY PERESS RAMY PERESS2013-07-05
5012011-01-01RAMY PERESS RAMY PERESS2012-07-09
5012009-01-01RAMY PERESS RAMY PERESS2010-07-27

Plan Statistics for STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125

401k plan membership statisitcs for STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125

Measure Date Value
2023: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2023 401k membership
Total participants, beginning-of-year2023-01-01190
Total number of active participants reported on line 7a of the Form 55002023-01-01194
Total of all active and inactive participants2023-01-01194
2022: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2022 401k membership
Total participants, beginning-of-year2022-01-01189
Total number of active participants reported on line 7a of the Form 55002022-01-01190
Total of all active and inactive participants2022-01-01190
2021: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2021 401k membership
Total participants, beginning-of-year2021-01-01185
Total number of active participants reported on line 7a of the Form 55002021-01-01189
Total of all active and inactive participants2021-01-01189
2020: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2020 401k membership
Total participants, beginning-of-year2020-01-01181
Total number of active participants reported on line 7a of the Form 55002020-01-01185
Total of all active and inactive participants2020-01-01185
2019: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2019 401k membership
Total participants, beginning-of-year2019-01-01178
Total number of active participants reported on line 7a of the Form 55002019-01-01181
Total of all active and inactive participants2019-01-01181
2018: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2018 401k membership
Total participants, beginning-of-year2018-01-01163
Total number of active participants reported on line 7a of the Form 55002018-01-01178
Total of all active and inactive participants2018-01-01178
2017: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2017 401k membership
Total participants, beginning-of-year2017-01-01167
Total number of active participants reported on line 7a of the Form 55002017-01-01163
Total of all active and inactive participants2017-01-01163
2016: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2016 401k membership
Total participants, beginning-of-year2016-01-01184
Total number of active participants reported on line 7a of the Form 55002016-01-01167
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01167
2015: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2015 401k membership
Total participants, beginning-of-year2015-01-01215
Total number of active participants reported on line 7a of the Form 55002015-01-01172
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-0122
Total of all active and inactive participants2015-01-01196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-011
Total participants2015-01-01197
Number of participants with account balances2015-01-01186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0110
2014: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2014 401k membership
Total participants, beginning-of-year2014-01-01220
Total number of active participants reported on line 7a of the Form 55002014-01-01172
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-0114
Total of all active and inactive participants2014-01-01187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-011
Total participants2014-01-01188
Number of participants with account balances2014-01-01175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-017
2013: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2013 401k membership
Total participants, beginning-of-year2013-01-01166
Total number of active participants reported on line 7a of the Form 55002013-01-01184
Number of retired or separated participants receiving benefits2013-01-011
Total of all active and inactive participants2013-01-01185
2012: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2012 401k membership
Total participants, beginning-of-year2012-01-01174
Total number of active participants reported on line 7a of the Form 55002012-01-01166
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01167
2011: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2011 401k membership
Total participants, beginning-of-year2011-01-01174
Total number of active participants reported on line 7a of the Form 55002011-01-01174
Number of retired or separated participants receiving benefits2011-01-011
Total of all active and inactive participants2011-01-01175
2009: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2009 401k membership
Total participants, beginning-of-year2009-01-01162
Total number of active participants reported on line 7a of the Form 55002009-01-01177
Number of retired or separated participants receiving benefits2009-01-012
Total of all active and inactive participants2009-01-01179

Form 5500 Responses for STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125

2023: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: STANDARD OIL OF CONNECTICUT INC CAFETERIA PLAN CODE SECTION 125 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0170029
Policy instance 2
Insurance contract or identification number0170029
Number of Individuals Covered262
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $92,839
Total amount of fees paid to insurance companyUSD $2,573
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,156,633
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 number307401
Policy instance 1
Insurance contract or identification number307401
Number of Individuals Covered194
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,704
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0170029
Policy instance 2
Insurance contract or identification number0170029
Number of Individuals Covered271
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $66,229
Total amount of fees paid to insurance companyUSD $83
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,670,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,962
Amount paid for insurance broker fees83
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number307401
Policy instance 1
Insurance contract or identification number307401
Number of Individuals Covered190
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,611
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,074
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number307401
Policy instance 1
Insurance contract or identification number307401
Number of Individuals Covered189
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,287
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $858
Amount paid for insurance broker fees0
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number0170029
Policy instance 2
Insurance contract or identification number0170029
Number of Individuals Covered296
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $59,674
Total amount of fees paid to insurance companyUSD $5,017
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,542,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,298
Amount paid for insurance broker fees17
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered185
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,146
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $764
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913378
Policy instance 2
Insurance contract or identification number913378
Number of Individuals Covered282
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $91,708
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,632,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $65,576
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0913378
Policy instance 1
Insurance contract or identification number0913378
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0913378
Policy instance 1
Insurance contract or identification number0913378
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,733
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,733
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913378
Policy instance 2
Insurance contract or identification number913378
Number of Individuals Covered272
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $86,009
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,510,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,122
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered181
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $588
Total amount of fees paid to insurance companyUSD $226
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $588
Amount paid for insurance broker fees226
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number
Policy instance 4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,361
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,765
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered175
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $514
Total amount of fees paid to insurance companyUSD $337
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $142
Amount paid for insurance broker fees337
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913378
Policy instance 2
Insurance contract or identification number913378
Number of Individuals Covered278
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $77,670
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,312,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,640
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0913378
Policy instance 1
Insurance contract or identification number0913378
Number of Individuals Covered122
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,833
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,833
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered168
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $512
Total amount of fees paid to insurance companyUSD $318
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $512
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Amount paid for insurance broker fees318
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract numberG1800
Policy instance 2
Insurance contract or identification numberG1800
Number of Individuals Covered217
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $30,048
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,399,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,048
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number164731
Policy instance 1
Insurance contract or identification number164731
Number of Individuals Covered121
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,439
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,439
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered185
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $576
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $576
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0904049
Policy instance 1
Insurance contract or identification number0904049
Number of Individuals Covered126
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $3,500
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,500
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC - NE
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00610187
Policy instance 2
Insurance contract or identification number00610187
Number of Individuals Covered185
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $63,630
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,794,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees63630
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00610187
Policy instance 2
Insurance contract or identification number00610187
Number of Individuals Covered192
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $56,167
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,458,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees56167
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered180
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $93
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
CONNECTICARE INSURANCE CO., INC (National Association of Insurance Commissioners NAIC id number: 11209 )
Policy contract number884
Policy instance 1
Insurance contract or identification number884
Number of Individuals Covered290
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,478
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,478
Additional information about fees paid to insurance brokerADMINSTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract numberG1800
Policy instance 2
Insurance contract or identification numberG1800
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,712
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,712
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES & BONUS
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $618
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $618
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
CONNECTICARE INSURANCE CO., INC (National Association of Insurance Commissioners NAIC id number: 11209 )
Policy contract number884
Policy instance 1
Insurance contract or identification number884
Number of Individuals Covered132
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,150
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,150
Additional information about fees paid to insurance brokerADMINSTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberS06863
Policy instance 4
Insurance contract or identification numberS06863
Number of Individuals Covered281
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $53,261
Total amount of fees paid to insurance companyUSD $3,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,313,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,261
Amount paid for insurance broker fees3000
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES/BONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC - CT
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $549
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $549
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract numberG1800
Policy instance 2
Insurance contract or identification numberG1800
Number of Individuals Covered310
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $36,623
Total amount of fees paid to insurance companyUSD $5,146
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,378,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,623
Amount paid for insurance broker fees5146
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES & BONUS
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
CONNECTICARE INSURANCE CO., INC (National Association of Insurance Commissioners NAIC id number: 11209 )
Policy contract number884
Policy instance 1
Insurance contract or identification number884
Number of Individuals Covered122
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,332
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,332
Additional information about fees paid to insurance brokerADMINSTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448778
Policy instance 1
Insurance contract or identification number5448778
Number of Individuals Covered124
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,587
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract numberG1800
Policy instance 2
Insurance contract or identification numberG1800
Number of Individuals Covered333
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $36,904
Total amount of fees paid to insurance companyUSD $5,250
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,296,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $509
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448778
Policy instance 1
Insurance contract or identification number5448778
Number of Individuals Covered131
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,904
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,460
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract numberG1800
Policy instance 2
Insurance contract or identification numberG1800
Number of Individuals Covered339
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $33,291
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,253,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,291
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES BONUS
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberG1400
Policy instance 3
Insurance contract or identification numberG1400
Number of Individuals Covered170
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $481
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $481
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker organization code?3
Insurance broker nameTHE NIA/UIA GROUP LLC

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