REFRIGERATED HOLDINGS INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN
| 2019: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: RHI HEALTH AND WELFARE PREMIUM PAYMENT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E5098652 |
| Policy instance | 4 |
| Insurance contract or identification number | E5098652 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $581 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $581 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 |
|
| HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 9 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 23 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,494 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Other welfare benefits provided | UNREIMBURSED MEDICAL ACCOUNT PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | UNREIMBURSED MEDICAL PLAN | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 1494 | | Additional information about fees paid to insurance broker | ADMINISTER UNREIMBURSED MEDICAL PLAN | | Insurance broker organization code? | 5 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0916469 |
| Policy instance | 7 |
| Insurance contract or identification number | 0916469 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $44,973 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,143,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP HEALTH INSURANCE PLAN | | Commission paid to Insurance Broker | USD $44,973 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 6 |
| Insurance contract or identification number | 06772 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other information about contract | DENTAL INSURANCE PLAN | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 5 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 136 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $10,896 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $58,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE, LTD & ADD SUPPLEMENTAL INSURANCE PLANS | | Commission paid to Insurance Broker | USD $9,566 | | Additional information about fees paid to insurance broker | COMMISSIONS PAID | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 3 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Other information about contract | GROUP HEALTH INSURANCE PLAN | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 2 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Other information about contract | GROUP PRESCRIPTION PLAN | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98438891001 |
| Policy instance | 1 |
| Insurance contract or identification number | 98438891001 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $885 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP VISION INSURANCE PLAN | | Commission paid to Insurance Broker | USD $885 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 8 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $823 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $823 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 |
|
| HEALTH SMART (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 8 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 18 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,261 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Other welfare benefits provided | UNREIMBURSED MEDICAL ACCOUNT PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | UNREIMBURSED MEDICAL PLAN | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 1261 | | Additional information about fees paid to insurance broker | ADMINISTER UNREIMBURSED MEDICAL PLAN | | Insurance broker organization code? | 5 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98438891001 |
| Policy instance | 1 |
| Insurance contract or identification number | 98438891001 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $973 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP VISION INSURANCE PLAN | | Commission paid to Insurance Broker | USD $973 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 7 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $353 | | Total amount of fees paid to insurance company | USD $15 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,130 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $353 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 6 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,266 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | DENTAL INSURANCE PLAN | | Commission paid to Insurance Broker | USD $65,027 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 5 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 124 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,503 | | Total amount of fees paid to insurance company | USD $751 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $54,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE, LTD & ADD SUPPLEMENTAL INSURANCE PLANS | | Commission paid to Insurance Broker | USD $7,503 | | Amount paid for insurance broker fees | 751 | | Additional information about fees paid to insurance broker | CONTRACTUAL BONUS ADMINISTRATIVE SVCS | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 4 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,150 | | Total amount of fees paid to insurance company | USD $75 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $1,150 | | Amount paid for insurance broker fees | 75 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHEMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 3 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $35,565 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $942,896 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP HEALTH INSURANCE PLAN | | Commission paid to Insurance Broker | USD $35,565 | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 2 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,980 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PRESCRIPTION PLAN | | Commission paid to Insurance Broker | USD $4,980 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 1 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $849 | | Total amount of fees paid to insurance company | USD $55 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $849 | | Amount paid for insurance broker fees | 55 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MISC BROKERS - COLONIAL LIFE INS |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 2 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,396 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $116,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,396 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98438891001 |
| Policy instance | 3 |
| Insurance contract or identification number | 98438891001 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $987 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP VISION INSURANCE PLAN | | Commission paid to Insurance Broker | USD $987 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 4 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,322 | | Total amount of fees paid to insurance company | USD $401 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $1,322 | | Amount paid for insurance broker fees | 401 | | Additional information about fees paid to insurance broker | SEE STATEMENT OF BASIS OF PREMIUM RATES ATTACHMENT COMMISSIONS & FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MISC BROKERS - COLONIAL LIFE INS CO |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 5 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,163 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | DENTAL INSURANCE PLAN | | Commission paid to Insurance Broker | USD $3,163 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 6 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $29,930 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $794,392 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PRESCRIPTION PLAN & HEALTH INSURANCE | | Commission paid to Insurance Broker | USD $29,930 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 7 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 111 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,671 | | Total amount of fees paid to insurance company | USD $561 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $51,049 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,671 | | Amount paid for insurance broker fees | 561 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON INSURANCE BROKERS LLC |
|
| HEALTHSMART (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 8 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 15 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | UNREIMBURSED MEDICAL ACCOUNT | | Welfare Benefit Premiums Paid to Carrier | USD $1,095 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 3 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,705 | | Total amount of fees paid to insurance company | USD $400 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $140 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 400 | | Additional information about fees paid to insurance broker | MISCELLANEOUS ADMINISTRATIVE SERVICES | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 6 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 109 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,555 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $47,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,555 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON INSURANCE BROKERS LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 5 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $24,716 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $716,011 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PRESCRIPTION PLAN & HEALTH INSURANCE | | Commission paid to Insurance Broker | USD $24,716 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 1 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,400 | | Total amount of fees paid to insurance company | USD $340 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,887 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $107 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 340 | | Additional information about fees paid to insurance broker | MISCELLANEOUS ADMINISTRATIVE SERVICES | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9843889 |
| Policy instance | 2 |
| Insurance contract or identification number | 9843889 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $795 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP VISION INSURANCE PLAN | | Commission paid to Insurance Broker | USD $795 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 4 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 1672882 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,882 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | DENTAL INSURANCE PLAN | | Commission paid to Insurance Broker | USD $2,882 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 3 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,127 | | Total amount of fees paid to insurance company | USD $747 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $109 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 747 | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9843889 |
| Policy instance | 2 |
| Insurance contract or identification number | 9843889 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $633 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP VISION INSURANCE PLAN | | Commission paid to Insurance Broker | USD $633 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 5 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,684 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $117,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP PRESCRIPTION PLAN | | Commission paid to Insurance Broker | USD $3,684 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 6 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,048 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $620,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | HEALTH INSURANCE PLAN | | Commission paid to Insurance Broker | USD $19,048 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 7 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 96 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,763 | | Total amount of fees paid to insurance company | USD $1,492 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $44,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | ADD LIFE & LTD PLANS | | Amount paid for insurance broker fees | 12 | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $6,763 | | Insurance broker name | LOCKTON INSURANCE BROKERS LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 1 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,062 | | Total amount of fees paid to insurance company | USD $738 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | LIFE INSURANCE INDIVIDUAL POLICIES | | Commission paid to Insurance Broker | USD $101 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 738 | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 4 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,745 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | DENTAL INSURANCE PLAN | | Commission paid to Insurance Broker | USD $2,745 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 7 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 101 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,492 | | Total amount of fees paid to insurance company | USD $60 | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 60 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 5 | | Insurance broker name | LOCKTON INSURANCE BROKERS LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 1 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,293 | | Total amount of fees paid to insurance company | USD $418 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $156 | | Amount paid for insurance broker fees | 17 | | Additional information about fees paid to insurance broker | SALES AND SERVICING | | Insurance broker organization code? | 3 | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9843889 |
| Policy instance | 2 |
| Insurance contract or identification number | 9843889 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $865 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $865 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 3 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,427 | | Total amount of fees paid to insurance company | USD $727 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $519 | | Amount paid for insurance broker fees | 56 | | Additional information about fees paid to insurance broker | SALES AND SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 4 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,765 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,765 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | SALES & SERVICING | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 5 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $21,998 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $638,574 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,998 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 6 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,044 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $117,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,044 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 6 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,686 | | Total amount of fees paid to insurance company | USD $0 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $117,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,553 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9843889 |
| Policy instance | 2 |
| Insurance contract or identification number | 9843889 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-02-28 | | Total amount of commissions paid to insurance broker | USD $768 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANY LLC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3714979 |
| Policy instance | 3 |
| Insurance contract or identification number | E3714979 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,171 | | Total amount of fees paid to insurance company | USD $1,760 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,751 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,292 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | MULTIPLE BROKERS - USED ORIGINAL SCHEDULE A AS ATTACHMENT TO REFLECT DETAILS. | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3733326 |
| Policy instance | 1 |
| Insurance contract or identification number | E3733326 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,245 | | Total amount of fees paid to insurance company | USD $518 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $202 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | MULTIPLE BROKERS - USED ORIGINAL SCHEDULE A AS ATTACHMENT TO REFLECT DETAILS | | Insurance broker name | MISCELLANEOUS MULTIPLE BROKERS |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 06772 |
| Policy instance | 4 |
| Insurance contract or identification number | 06772 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,901 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,094 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,901 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | J SMITH LANIER AND CO |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 7 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 99 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,356 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $52,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,156 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9843889 |
| Policy instance | 8 |
| Insurance contract or identification number | 9843889 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $565 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,318 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $498 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 5 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,626 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $693,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,931 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 4 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,143 | | Total amount of fees paid to insurance company | USD $0 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,815 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 3 |
| Insurance contract or identification number | 85497 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $24,463 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $608,797 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 6772 |
| Policy instance | 2 |
| Insurance contract or identification number | 6772 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,614 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-035041 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-035041 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $692 | | Total amount of fees paid to insurance company | USD $261 | | Vision Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 5 |
| Insurance contract or identification number | 865258G | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,571 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 3 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $33,879 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $848,668 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 865258G |
| Policy instance | 5 |
| Insurance contract or identification number | 865258G | | Number of Individuals Covered | 92 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $12,079 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $0 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-035041 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-035041 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2010-03-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $850 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 6772 |
| Policy instance | 2 |
| Insurance contract or identification number | 6772 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,668 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes |
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| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 85497 |
| Policy instance | 4 |
| Insurance contract or identification number | 85497 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,400 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $135,328 |
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