THE VITA COCO COMPANY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN
401k plan membership statisitcs for ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2022: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-08-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 175 |
Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
Total of all active and inactive participants | 2022-08-01 | 175 |
Number of employers contributing to the scheme | 2022-08-01 | 0 |
2021: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-08-01 | 199 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 197 |
Number of retired or separated participants receiving benefits | 2021-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
Total of all active and inactive participants | 2021-08-01 | 200 |
2020: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-08-01 | 240 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 197 |
Number of retired or separated participants receiving benefits | 2020-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
Total of all active and inactive participants | 2020-08-01 | 199 |
2019: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-08-01 | 247 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 236 |
Number of retired or separated participants receiving benefits | 2019-08-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
Total of all active and inactive participants | 2019-08-01 | 240 |
2018: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-08-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 139 |
Number of retired or separated participants receiving benefits | 2018-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
Total of all active and inactive participants | 2018-08-01 | 142 |
2017: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-08-01 | 195 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 145 |
Number of retired or separated participants receiving benefits | 2017-08-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
Total of all active and inactive participants | 2017-08-01 | 149 |
2016: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-08-01 | 142 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 151 |
Number of retired or separated participants receiving benefits | 2016-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
Total of all active and inactive participants | 2016-08-01 | 153 |
2015: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-08-01 | 154 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 134 |
Number of retired or separated participants receiving benefits | 2015-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
Total of all active and inactive participants | 2015-08-01 | 137 |
2014: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-08-01 | 144 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 146 |
Number of retired or separated participants receiving benefits | 2014-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
Total of all active and inactive participants | 2014-08-01 | 148 |
2013: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-08-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 141 |
Number of retired or separated participants receiving benefits | 2013-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 0 |
Total of all active and inactive participants | 2013-08-01 | 143 |
2022: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2022 form 5500 responses |
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2022-08-01 | Type of plan entity | Single employer plan |
2022-08-01 | Plan funding arrangement – Insurance | Yes |
2022-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-08-01 | Plan benefit arrangement – Insurance | Yes |
2022-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2021 form 5500 responses |
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2021-08-01 | Type of plan entity | Single employer plan |
2021-08-01 | Submission has been amended | No |
2021-08-01 | This submission is the final filing | No |
2021-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-08-01 | Plan is a collectively bargained plan | No |
2021-08-01 | Plan funding arrangement – Insurance | Yes |
2021-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-08-01 | Plan benefit arrangement – Insurance | Yes |
2021-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2020 form 5500 responses |
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2020-08-01 | Type of plan entity | Single employer plan |
2020-08-01 | Submission has been amended | No |
2020-08-01 | This submission is the final filing | No |
2020-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-08-01 | Plan is a collectively bargained plan | No |
2020-08-01 | Plan funding arrangement – Insurance | Yes |
2020-08-01 | Plan benefit arrangement – Insurance | Yes |
2019: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2019 form 5500 responses |
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2019-08-01 | Type of plan entity | Single employer plan |
2019-08-01 | Submission has been amended | No |
2019-08-01 | This submission is the final filing | No |
2019-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-08-01 | Plan is a collectively bargained plan | No |
2019-08-01 | Plan funding arrangement – Insurance | Yes |
2019-08-01 | Plan benefit arrangement – Insurance | Yes |
2018: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2018 form 5500 responses |
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2018-08-01 | Type of plan entity | Single employer plan |
2018-08-01 | Submission has been amended | No |
2018-08-01 | This submission is the final filing | No |
2018-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-08-01 | Plan is a collectively bargained plan | No |
2018-08-01 | Plan funding arrangement – Insurance | Yes |
2018-08-01 | Plan benefit arrangement – Insurance | Yes |
2017: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2017 form 5500 responses |
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2017-08-01 | Type of plan entity | Single employer plan |
2017-08-01 | Submission has been amended | No |
2017-08-01 | This submission is the final filing | No |
2017-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-08-01 | Plan is a collectively bargained plan | No |
2017-08-01 | Plan funding arrangement – Insurance | Yes |
2017-08-01 | Plan benefit arrangement – Insurance | Yes |
2016: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2016 form 5500 responses |
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2016-08-01 | Type of plan entity | Single employer plan |
2016-08-01 | Submission has been amended | No |
2016-08-01 | This submission is the final filing | No |
2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-08-01 | Plan is a collectively bargained plan | No |
2016-08-01 | Plan funding arrangement – Insurance | Yes |
2016-08-01 | Plan benefit arrangement – Insurance | Yes |
2015: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2015 form 5500 responses |
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2015-08-01 | Type of plan entity | Single employer plan |
2015-08-01 | Submission has been amended | No |
2015-08-01 | This submission is the final filing | No |
2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-08-01 | Plan is a collectively bargained plan | No |
2015-08-01 | Plan funding arrangement – Insurance | Yes |
2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-08-01 | Plan benefit arrangement – Insurance | Yes |
2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2014 form 5500 responses |
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2014-08-01 | Type of plan entity | Single employer plan |
2014-08-01 | Submission has been amended | No |
2014-08-01 | This submission is the final filing | No |
2014-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-08-01 | Plan is a collectively bargained plan | No |
2014-08-01 | Plan funding arrangement – Insurance | Yes |
2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-08-01 | Plan benefit arrangement – Insurance | Yes |
2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: ALL MARKET INC. , DBA VITA COCO HEALTH AND WELFARE PLAN 2013 form 5500 responses |
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2013-08-01 | Type of plan entity | Single employer plan |
2013-08-01 | Submission has been amended | Yes |
2013-08-01 | This submission is the final filing | No |
2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-08-01 | Plan is a collectively bargained plan | No |
2013-08-01 | Plan funding arrangement – Insurance | Yes |
2013-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-08-01 | Plan benefit arrangement – Insurance | Yes |
2013-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
Policy contract number | 720891 |
Policy instance | 2 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 44 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $7,704 | Total amount of fees paid to insurance company | USD $704 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $51,361 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,450 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 300 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $58,255 | Total amount of fees paid to insurance company | USD $4,944 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $1,927,796 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,261 | Amount paid for insurance broker fees | 3828 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
Policy contract number | 720891 |
Policy instance | 2 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 81 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $6,931 | Total amount of fees paid to insurance company | USD $712 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $43,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $6,931 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 712 | Additional information about fees paid to insurance broker | FEES |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 312 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $55,499 | Total amount of fees paid to insurance company | USD $1,037 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,690,767 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $55,499 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1037 | Additional information about fees paid to insurance broker | FEES PAID |
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ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
Policy contract number | 720891 |
Policy instance | 2 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 79 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $4,074 | Total amount of fees paid to insurance company | USD $1,060 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $30,820 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,204 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1060 | Additional information about fees paid to insurance broker | FEES |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 158 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $43,183 | Total amount of fees paid to insurance company | USD $5,647 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,436,881 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,926 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4230 | Additional information about fees paid to insurance broker | FEES |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 241 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $37,068 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,553,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,068 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 225 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $4,476 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $62,959 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,476 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 3 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 42 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $2,107 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,986 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,107 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H71373 |
Policy instance | 4 |
Insurance contract or identification number | H71373 | Number of Individuals Covered | 2 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $42 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $421 | 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 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H71373 |
Policy instance | 4 |
Insurance contract or identification number | H71373 | Number of Individuals Covered | 2 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $52 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $517 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $52 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 3 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 37 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $3,117 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $23,286 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,117 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 235 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $4,224 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $81,796 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,224 | Insurance broker organization code? | 3 |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 242 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $38,643 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,489,014 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $38,643 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H71373 |
Policy instance | 4 |
Insurance contract or identification number | H71373 | Number of Individuals Covered | 2 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $50 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $498 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $50 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 3 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 71 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $3,706 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $34,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,706 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 230 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $4,418 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $82,102 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,418 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 230 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $39,221 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,162,268 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $39,154 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 222 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $34,442 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,048,489 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,442 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 209 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $4,238 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $60,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,238 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | H71373 |
Policy instance | 3 |
Insurance contract or identification number | H71373 | Number of Individuals Covered | 2 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $44 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $44 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 4 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 39 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $3,264 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $25,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,264 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 3 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 38 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $2,360 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,681 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,360 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 236 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $4,135 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $88,477 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,135 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 249 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $40,462 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,030,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,462 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS, LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 303710 |
Policy instance | 3 |
Insurance contract or identification number | 303710 | Number of Individuals Covered | 36 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $2,090 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,091 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,090 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS LLC |
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EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
Policy contract number | 720891 |
Policy instance | 1 |
Insurance contract or identification number | 720891 | Number of Individuals Covered | 234 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $28,002 | Total amount of fees paid to insurance company | USD $9,520 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $794,417 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,002 | Amount paid for insurance broker fees | 9520 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS LLC |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1020811 |
Policy instance | 2 |
Insurance contract or identification number | 1020811 | Number of Individuals Covered | 218 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $4,039 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $66,781 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,039 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH AND BENEFITS LLC |
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