TOM FORD RETAIL LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 138 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 139 |
| 2021: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 122 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 124 |
| 2020: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 139 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 139 |
| 2019: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 274 |
| Total of all active and inactive participants | 2019-02-01 | 274 |
| 2018: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 267 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 252 |
| Total of all active and inactive participants | 2018-02-01 | 252 |
| 2017: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 267 |
| Total of all active and inactive participants | 2017-02-01 | 267 |
| 2016: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 263 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 281 |
| Total of all active and inactive participants | 2016-02-01 | 281 |
| 2015: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 263 |
| Total of all active and inactive participants | 2015-02-01 | 263 |
| 2014: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 223 |
| Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
| Total of all active and inactive participants | 2014-02-01 | 223 |
| 2013: TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 125 |
| Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
| Total of all active and inactive participants | 2013-02-01 | 125 |
| Measure | Date | Value |
|---|
| 2019 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $2,312,875 |
| Total of all expenses incurred | 2019-12-31 | $2,312,875 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $2,312,875 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $2,312,875 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,312,875 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $2,312,875 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Qualified |
| Accountancy firm name | 2019-12-31 | RSM US LLP |
| Accountancy firm EIN | 2019-12-31 | 420714325 |
| Total income from all sources (including contributions) | 2019-01-31 | $2,043,698 |
| Total of all expenses incurred | 2019-01-31 | $2,043,698 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-01-31 | $2,043,698 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-01-31 | $2,043,698 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-01-31 | No |
| Was this plan covered by a fidelity bond | 2019-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-01-31 | No |
| Value of net income/loss | 2019-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-01-31 | $2,043,698 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-01-31 | No |
| Contributions received in cash from employer | 2019-01-31 | $2,043,698 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-01-31 | No |
| Did the plan have assets held for investment | 2019-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-01-31 | Qualified |
| Accountancy firm name | 2019-01-31 | RSM US LLP |
| Accountancy firm EIN | 2019-01-31 | 420714325 |
| 2018 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-01-31 | $2,076,986 |
| Total of all expenses incurred | 2018-01-31 | $2,076,986 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-01-31 | $2,076,986 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-01-31 | $2,076,986 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-01-31 | No |
| Was this plan covered by a fidelity bond | 2018-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2018-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-01-31 | No |
| Value of net income/loss | 2018-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-01-31 | $2,076,986 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-01-31 | No |
| Contributions received in cash from employer | 2018-01-31 | $2,076,986 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-01-31 | No |
| Did the plan have assets held for investment | 2018-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-01-31 | Qualified |
| Accountancy firm name | 2018-01-31 | RSM US LLP |
| Accountancy firm EIN | 2018-01-31 | 420714325 |
| 2017 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-01-31 | $2,015,998 |
| Total of all expenses incurred | 2017-01-31 | $2,015,998 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-01-31 | $2,015,998 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-01-31 | $2,015,998 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-01-31 | No |
| Was this plan covered by a fidelity bond | 2017-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2017-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
| Value of net income/loss | 2017-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-01-31 | $2,015,998 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-01-31 | No |
| Contributions received in cash from employer | 2017-01-31 | $2,015,998 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-01-31 | No |
| Did the plan have assets held for investment | 2017-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-01-31 | Qualified |
| Accountancy firm name | 2017-01-31 | RSM US LLP |
| Accountancy firm EIN | 2017-01-31 | 420714325 |
| 2016 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-01-31 | $1,705,997 |
| Total of all expenses incurred | 2016-01-31 | $1,705,997 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-01-31 | $1,705,997 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-01-31 | $1,705,997 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-01-31 | No |
| Was this plan covered by a fidelity bond | 2016-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-01-31 | No |
| Value of net income/loss | 2016-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-01-31 | $1,705,997 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-01-31 | No |
| Contributions received in cash from employer | 2016-01-31 | $1,705,997 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-01-31 | No |
| Did the plan have assets held for investment | 2016-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-01-31 | Qualified |
| Accountancy firm name | 2016-01-31 | RSM US LLP |
| Accountancy firm EIN | 2016-01-31 | 420714325 |
| 2015 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-01-31 | $1,620,506 |
| Total of all expenses incurred | 2015-01-31 | $1,620,506 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-01-31 | $1,620,506 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-01-31 | $1,620,506 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-01-31 | No |
| Was this plan covered by a fidelity bond | 2015-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
| Value of net income/loss | 2015-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-01-31 | $1,620,506 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-01-31 | No |
| Contributions received in cash from employer | 2015-01-31 | $1,620,506 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-01-31 | No |
| Did the plan have assets held for investment | 2015-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-01-31 | Qualified |
| Accountancy firm name | 2015-01-31 | MCGLADREY LLP |
| Accountancy firm EIN | 2015-01-31 | 420714325 |
| 2014 : TOM FORD RETAIL HEALTH & WELFARE BENEFITS PLAN 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-01-31 | $956,524 |
| Total of all expenses incurred | 2014-01-31 | $956,524 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-01-31 | $956,524 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-01-31 | $956,524 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-01-31 | No |
| Was this plan covered by a fidelity bond | 2014-01-31 | No |
| If this is an individual account plan, was there a blackout period | 2014-01-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-01-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
| Value of net income/loss | 2014-01-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-01-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-01-31 | $956,524 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-01-31 | No |
| Contributions received in cash from employer | 2014-01-31 | $956,524 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-01-31 | No |
| Did the plan have assets held for investment | 2014-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-01-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-01-31 | Qualified |
| Accountancy firm name | 2014-01-31 | MCGLADREY LLP |
| Accountancy firm EIN | 2014-01-31 | 420714325 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30031317 |
| Policy instance | 3 |
| Insurance contract or identification number | 30031317 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,266 | | 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 | 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 $16,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,029 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 910744 |
| Policy instance | 2 |
| Insurance contract or identification number | 910744 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $13,581 | | Total amount of fees paid to insurance company | USD $4,019 | | 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 | 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 $104,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,922 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4019 | | Additional information about fees paid to insurance broker | BONUS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 242502 |
| Policy instance | 1 |
| Insurance contract or identification number | 242502 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $91,479 | | Total amount of fees paid to insurance company | USD $24,220 | | 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 $2,056,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $91,479 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 24220 | | Additional information about fees paid to insurance broker | OVERRIDE |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30031317 |
| Policy instance | 3 |
| Insurance contract or identification number | 30031317 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,108 | | 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 | 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 $17,961 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $946 | | Insurance broker organization code? | 3 |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0910744 |
| Policy instance | 2 |
| Insurance contract or identification number | 0910744 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,109 | | 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 | 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 $96,574 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,063 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0242502 |
| Policy instance | 1 |
| Insurance contract or identification number | 0242502 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $103,573 | | 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 $2,025,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,593 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | OVERRIDES |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
| Policy contract number | 30031317 |
| Policy instance | 3 |
| Insurance contract or identification number | 30031317 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,439 | | 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 | 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 $19,548 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,439 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0910744 |
| Policy instance | 2 |
| Insurance contract or identification number | 0910744 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $13,166 | | 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 | 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 $109,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,680 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0242502 |
| Policy instance | 1 |
| Insurance contract or identification number | 0242502 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $84,224 | | Total amount of fees paid to insurance company | USD $25,662 | | 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 $2,275,681 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $84,224 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 25662 | | Additional information about fees paid to insurance broker | OVERRIDES |
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| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $89,022 | | Total amount of fees paid to insurance company | USD $27,370 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,312,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $89,022 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 27370 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $84,409 | | Total amount of fees paid to insurance company | USD $26,810 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,043,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $84,409 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 26810 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 267 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $83,139 | | Total amount of fees paid to insurance company | USD $25,900 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,076,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $83,139 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 25900 | | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $66,319 | | Total amount of fees paid to insurance company | USD $22,498 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,705,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,319 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 22498 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $63,456 | | Total amount of fees paid to insurance company | USD $22,750 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,620,506 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,456 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 22750 | | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | TF7885 |
| Policy instance | 1 |
| Insurance contract or identification number | TF7885 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $37,656 | | Total amount of fees paid to insurance company | USD $16,030 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $956,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,656 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16030 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker name | CENTERSTONE INS & FINANCIAL SVC/WIB |
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