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GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 401k Plan overview

Plan NameGROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA
Plan identification number 501

GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

KAJIMA U.S.A. INC. has sponsored the creation of one or more 401k plans.

Company Name:KAJIMA U.S.A. INC.
Employer identification number (EIN):133381982
NAIC Classification:236200

Additional information about KAJIMA U.S.A. INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2107972

More information about KAJIMA U.S.A. INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01ROBERT BROWN
5012017-01-01ROBERT BROWN
5012016-01-01ROBERT BROWN
5012015-01-01ROBERT BROWN
5012014-01-01SHOHEI GONDA
5012013-01-01SHOHEI GONDA
5012012-01-01SHOHEI GONDA
5012011-01-01SHOHEI GONDA
5012010-01-01SHOHEI GONDA
5012009-01-01KENT STOLTZMAN

Plan Statistics for GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA

401k plan membership statisitcs for GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA

Measure Date Value
2022: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2022 401k membership
Total participants, beginning-of-year2022-01-01502
Total number of active participants reported on line 7a of the Form 55002022-01-01544
Total of all active and inactive participants2022-01-01544
Total participants2022-01-01544
2021: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2021 401k membership
Total participants, beginning-of-year2021-01-011,070
Total number of active participants reported on line 7a of the Form 55002021-01-01502
Total of all active and inactive participants2021-01-01502
Total participants2021-01-01502
2020: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2020 401k membership
Total participants, beginning-of-year2020-01-01435
Total number of active participants reported on line 7a of the Form 55002020-01-01448
Total of all active and inactive participants2020-01-01448
Total participants2020-01-01448
2019: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2019 401k membership
Total participants, beginning-of-year2019-01-01389
Total number of active participants reported on line 7a of the Form 55002019-01-01435
Total of all active and inactive participants2019-01-01435
Total participants2019-01-01435
Number of participants with account balances2019-01-010
2018: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2018 401k membership
Total participants, beginning-of-year2018-01-01357
Total number of active participants reported on line 7a of the Form 55002018-01-01389
Total of all active and inactive participants2018-01-01389
Total participants2018-01-01389
2017: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2017 401k membership
Total participants, beginning-of-year2017-01-01333
Total number of active participants reported on line 7a of the Form 55002017-01-01357
Total of all active and inactive participants2017-01-01357
Total participants2017-01-01357
2016: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2016 401k membership
Total participants, beginning-of-year2016-01-01347
Total number of active participants reported on line 7a of the Form 55002016-01-01333
Total of all active and inactive participants2016-01-01333
Total participants2016-01-01333
2015: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2015 401k membership
Total participants, beginning-of-year2015-01-01400
Total number of active participants reported on line 7a of the Form 55002015-01-01347
Total of all active and inactive participants2015-01-01347
Total participants2015-01-010
2014: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2014 401k membership
Total participants, beginning-of-year2014-01-01773
Total number of active participants reported on line 7a of the Form 55002014-01-01400
Total of all active and inactive participants2014-01-01400
Total participants2014-01-010
2013: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2013 401k membership
Total participants, beginning-of-year2013-01-01816
Total number of active participants reported on line 7a of the Form 55002013-01-01770
Number of retired or separated participants receiving benefits2013-01-013
Total of all active and inactive participants2013-01-01773
Total participants2013-01-010
2012: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2012 401k membership
Total participants, beginning-of-year2012-01-01768
Total number of active participants reported on line 7a of the Form 55002012-01-01814
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01816
2011: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2011 401k membership
Total participants, beginning-of-year2011-01-01765
Total number of active participants reported on line 7a of the Form 55002011-01-01790
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01790
2010: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2010 401k membership
Total participants, beginning-of-year2010-01-01849
Total number of active participants reported on line 7a of the Form 55002010-01-01765
Number of retired or separated participants receiving benefits2010-01-0122
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01787
2009: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2009 401k membership
Total participants, beginning-of-year2009-01-01548
Total number of active participants reported on line 7a of the Form 55002009-01-01860
Number of retired or separated participants receiving benefits2009-01-0144
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01904

Form 5500 Responses for GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA

2022: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
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
2010: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: GROUP LIFE, HEALTH AND DENTAL PLAN FOR ALL SALARIED EMPLOYEES OF KAJIMA 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
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

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL35913
Policy instance 1
Insurance contract or identification numberHCL35913
Number of Individuals Covered544
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $56,514
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $949,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees56514
Additional information about fees paid to insurance brokerOTHER PAYMENTS
Insurance broker organization code?5
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGB0532
Policy instance 2
Insurance contract or identification numberGB0532
Number of Individuals Covered1176
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $-923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 1
Insurance contract or identification number9857780
Number of Individuals Covered971
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,037
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,037
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGB0532
Policy instance 2
Insurance contract or identification numberGB0532
Number of Individuals Covered1070
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $666,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 1
Insurance contract or identification number9857780
Number of Individuals Covered865
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,984
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,984
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered1011
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $60,006
Total amount of fees paid to insurance companyUSD $8,342
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,487,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,006
Insurance broker organization code?3
Amount paid for insurance broker fees8342
Additional information about fees paid to insurance brokerSERVICE/GEN AGENT FEES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 2
Insurance contract or identification number9857780
Number of Individuals Covered803
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,944
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,944
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered957
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $65,007
Total amount of fees paid to insurance companyUSD $3,731
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,220,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $65,007
Amount paid for insurance broker fees3731
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 2
Insurance contract or identification number9857780
Number of Individuals Covered781
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,088
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,088
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 2
Insurance contract or identification number9857780
Number of Individuals Covered763
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,665
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,665
Insurance broker organization code?3
Insurance broker nameJ. SMITH LANIER & CO.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered950
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $60,011
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,087,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,011
Insurance broker organization code?3
Insurance broker nameJ. SMITH LANIER
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered881
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $59,997
Total amount of fees paid to insurance companyUSD $297
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $800,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,997
Amount paid for insurance broker fees297
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 2
Insurance contract or identification number9857780
Number of Individuals Covered661
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,042
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,042
Insurance broker nameJ. SMITH LANIER & CO.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 3
Insurance contract or identification number9857780
Number of Individuals Covered403
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,361
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,499
Insurance broker nameMERCER HEALTH & BENEFITS
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered846
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $74,995
Total amount of fees paid to insurance companyUSD $1,269
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $692,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,999
Amount paid for insurance broker fees1269
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameJ. SMITH LANIER
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberD230
Policy instance 2
Insurance contract or identification numberD230
Number of Individuals Covered718
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $24,020
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $240,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,224
Insurance broker nameMERCER HEALTH & BENEFITS
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551/D230
Policy instance 2
Insurance contract or identification numberQ3551/D230
Number of Individuals Covered871
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $33,167
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $331,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,167
Insurance broker nameMERCER HEALTH & BENEFITS
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered1169
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $82,503
Total amount of fees paid to insurance companyUSD $1,834
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $830,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,503
Amount paid for insurance broker fees1834
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9857780
Policy instance 3
Insurance contract or identification number9857780
Number of Individuals Covered463
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,727
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,727
Insurance broker nameMERCER HEALTH & BENEFITS
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551-15
Policy instance 3
Insurance contract or identification numberQ3551-15
Number of Individuals Covered484
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $14,693
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $146,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,693
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH AND BENEFITS
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered1107
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $97,501
Total amount of fees paid to insurance companyUSD $1,520
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $702,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,501
Amount paid for insurance broker fees1520
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH AND BENEFITS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number501995
Policy instance 4
Insurance contract or identification number501995
Number of Individuals Covered174
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,699
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $26,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,699
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH AND BENEFITS, LLC
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551
Policy instance 2
Insurance contract or identification numberQ3551
Number of Individuals Covered861
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $31,988
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $326,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,988
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH AND BENEFITS
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551-15
Policy instance 3
Insurance contract or identification numberQ3551-15
Number of Individuals Covered293
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $13,935
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & 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 CarrierUSD $139,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551
Policy instance 2
Insurance contract or identification numberQ3551
Number of Individuals Covered490
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $29,283
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & 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 CarrierUSD $292,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered1093
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $82,502
Total amount of fees paid to insurance companyUSD $1,100
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $618,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3212924
Policy instance 1
Insurance contract or identification number3212924
Number of Individuals Covered1087
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $97,496
Total amount of fees paid to insurance companyUSD $1,200
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $716,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $97,496
Amount paid for insurance broker fees1200
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 )
Policy contract numberQ3551
Policy instance 2
Insurance contract or identification numberQ3551
Number of Individuals Covered750
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $43,066
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & 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 CarrierUSD $430,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,066
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC

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