3MD, INC. has sponsored the creation of one or more 401k plans.
Additional information about 3MD, INC.
Submission information for form 5500 for 401k plan DENALI HEALTH & WELFARE BENEFIT PLAN
Measure | Date | Value |
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2022: DENALI HEALTH & WELFARE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-10-01 | 539 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 572 |
Number of retired or separated participants receiving benefits | 2022-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 0 |
Total of all active and inactive participants | 2022-10-01 | 572 |
Number of employers contributing to the scheme | 2022-10-01 | 0 |
2021: DENALI HEALTH & WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 539 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 593 |
Number of retired or separated participants receiving benefits | 2021-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
Total of all active and inactive participants | 2021-10-01 | 593 |
Number of employers contributing to the scheme | 2021-10-01 | 0 |
2020: DENALI HEALTH & WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 427 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 539 |
Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
Total of all active and inactive participants | 2020-10-01 | 539 |
Number of employers contributing to the scheme | 2020-10-01 | 0 |
2019: DENALI HEALTH & WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 369 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 427 |
Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
Total of all active and inactive participants | 2019-10-01 | 427 |
Number of employers contributing to the scheme | 2019-10-01 | 0 |
2018: DENALI HEALTH & WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 361 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 369 |
Number of retired or separated participants receiving benefits | 2018-10-01 | 1 |
Total of all active and inactive participants | 2018-10-01 | 370 |
Total participants | 2018-10-01 | 370 |
2017: DENALI HEALTH & WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 373 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 366 |
Number of retired or separated participants receiving benefits | 2017-10-01 | 4 |
Total of all active and inactive participants | 2017-10-01 | 370 |
Total participants | 2017-10-01 | 370 |
2016: DENALI HEALTH & WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 343 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 367 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 2 |
Total of all active and inactive participants | 2016-10-01 | 369 |
Total participants | 2016-10-01 | 369 |
2015: DENALI HEALTH & WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 366 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 333 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 5 |
Total of all active and inactive participants | 2015-10-01 | 338 |
Total participants | 2015-10-01 | 338 |
2014: DENALI HEALTH & WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 314 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 353 |
Number of retired or separated participants receiving benefits | 2014-10-01 | 5 |
Total of all active and inactive participants | 2014-10-01 | 358 |
Total participants | 2014-10-01 | 358 |
2013: DENALI HEALTH & WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 361 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 392 |
Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
Total of all active and inactive participants | 2013-10-01 | 392 |
2012: DENALI HEALTH & WELFARE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 347 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 361 |
Total of all active and inactive participants | 2012-10-01 | 361 |
2011: DENALI HEALTH & WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-10-01 | 303 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 347 |
Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
Total of all active and inactive participants | 2011-10-01 | 347 |
2010: DENALI HEALTH & WELFARE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-10-01 | 249 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 303 |
Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 0 |
Total of all active and inactive participants | 2010-10-01 | 303 |
2009: DENALI HEALTH & WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-11-01 | 190 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 249 |
Total of all active and inactive participants | 2009-11-01 | 249 |
2022: DENALI HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses |
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2022-10-01 | Type of plan entity | Single employer plan |
2022-10-01 | Plan funding arrangement – Insurance | Yes |
2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-10-01 | Plan benefit arrangement – Insurance | Yes |
2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: DENALI HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Plan funding arrangement – Insurance | Yes |
2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: DENALI HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Plan funding arrangement – Insurance | Yes |
2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: DENALI HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses |
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2019-10-01 | Type of plan entity | Single employer plan |
2019-10-01 | Plan funding arrangement – Insurance | Yes |
2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-10-01 | Plan benefit arrangement – Insurance | Yes |
2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: DENALI HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Submission has been amended | No |
2018-10-01 | This submission is the final filing | No |
2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-10-01 | Plan is a collectively bargained plan | No |
2018-10-01 | Plan funding arrangement – Insurance | Yes |
2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: DENALI HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Submission has been amended | No |
2017-10-01 | This submission is the final filing | No |
2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-10-01 | Plan is a collectively bargained plan | No |
2017-10-01 | Plan funding arrangement – Insurance | Yes |
2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: DENALI HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2015: DENALI HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2014: DENALI HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses |
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2014-10-01 | Type of plan entity | Single employer plan |
2014-10-01 | Submission has been amended | No |
2014-10-01 | This submission is the final filing | No |
2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-10-01 | Plan is a collectively bargained plan | No |
2014-10-01 | Plan funding arrangement – Insurance | Yes |
2014-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-10-01 | Plan benefit arrangement – Insurance | Yes |
2014-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: DENALI HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses |
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2013-10-01 | Type of plan entity | Single employer plan |
2013-10-01 | Submission has been amended | No |
2013-10-01 | This submission is the final filing | No |
2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-10-01 | Plan is a collectively bargained plan | No |
2013-10-01 | Plan funding arrangement – Insurance | Yes |
2013-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-10-01 | Plan benefit arrangement – Insurance | Yes |
2013-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: DENALI HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses |
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2012-10-01 | Type of plan entity | Single employer plan |
2012-10-01 | Submission has been amended | No |
2012-10-01 | This submission is the final filing | No |
2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-10-01 | Plan is a collectively bargained plan | No |
2012-10-01 | Plan funding arrangement – Insurance | Yes |
2012-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-10-01 | Plan benefit arrangement – Insurance | Yes |
2012-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: DENALI HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses |
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2011-10-01 | Type of plan entity | Single employer plan |
2011-10-01 | Submission has been amended | No |
2011-10-01 | This submission is the final filing | No |
2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-10-01 | Plan is a collectively bargained plan | No |
2011-10-01 | Plan funding arrangement – Insurance | Yes |
2011-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-10-01 | Plan benefit arrangement – Insurance | Yes |
2011-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: DENALI HEALTH & WELFARE BENEFIT PLAN 2010 form 5500 responses |
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2010-10-01 | Type of plan entity | Single employer plan |
2010-10-01 | Submission has been amended | No |
2010-10-01 | This submission is the final filing | No |
2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-10-01 | Plan is a collectively bargained plan | No |
2010-10-01 | Plan funding arrangement – Insurance | Yes |
2010-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-10-01 | Plan benefit arrangement – Insurance | Yes |
2010-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: DENALI HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses |
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2009-11-01 | Type of plan entity | Single employer plan |
2009-11-01 | Submission has been amended | No |
2009-11-01 | This submission is the final filing | No |
2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2009-11-01 | Plan is a collectively bargained plan | No |
2009-11-01 | Plan funding arrangement – Insurance | Yes |
2009-11-01 | Plan benefit arrangement – Insurance | Yes |
2008: DENALI HEALTH & WELFARE BENEFIT PLAN 2008 form 5500 responses |
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2008-11-01 | Type of plan entity | Single employer plan |
2008-11-01 | Submission has been amended | No |
2008-11-01 | This submission is the final filing | No |
2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-11-01 | Plan is a collectively bargained plan | No |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0C5W3 |
Policy instance | 2 |
Insurance contract or identification number | GVTL0C5W3 | Number of Individuals Covered | 556 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $16,932 | Total amount of fees paid to insurance company | USD $2,374 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT,CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $183,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,932 | Amount paid for insurance broker fees | 2374 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 341 | Insurance policy start date | 2022-10-01 | Insurance policy end date | 2023-09-30 | Total amount of commissions paid to insurance broker | USD $1,912 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,073 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,912 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 2 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 593 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $17,993 | Total amount of fees paid to insurance company | USD $7,269 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $179,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,993 | Amount paid for insurance broker fees | 7269 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 356 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $1,915 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,137 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,915 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 2 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 539 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $16,059 | Total amount of fees paid to insurance company | USD $5,650 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $160,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,059 | Amount paid for insurance broker fees | 5650 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 309 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $1,816 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,562 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,816 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 3 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 427 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $11,832 | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $118,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,777 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 2 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 279 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $1,368 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,596 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,123 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 03993 |
Policy instance | 1 |
Insurance contract or identification number | 03993 | Number of Individuals Covered | 636 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $10,775 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,775 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3340109 |
Policy instance | 2 |
Insurance contract or identification number | 3340109 | Number of Individuals Covered | 519 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | 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 $395,579 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $121 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 03993 |
Policy instance | 3 |
Insurance contract or identification number | 03993 | Number of Individuals Covered | 550 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $22,229 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,229 | Insurance broker organization code? | 3 |
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LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 4 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 415 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $9,981 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $116,726 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,981 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 246 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $1,376 | 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 $29,079 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,376 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 4 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 235 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,385 | 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 $29,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 3 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 406 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $10,032 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $100,319 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 03993 |
Policy instance | 2 |
Insurance contract or identification number | 03993 | Number of Individuals Covered | 538 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $20,168 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3340109 |
Policy instance | 1 |
Insurance contract or identification number | 3340109 | Number of Individuals Covered | 506 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $67,305 | 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 $403,621 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
Policy contract number | 10012655 |
Policy instance | 4 |
Insurance contract or identification number | 10012655 | Number of Individuals Covered | 503 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $73,484 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,556,304 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $73,484 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES, INC. |
|
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 03993 |
Policy instance | 1 |
Insurance contract or identification number | 03993 | Number of Individuals Covered | 510 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $20,355 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,355 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFITS SERVICES, INC. |
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LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | WA300996 |
Policy instance | 2 |
Insurance contract or identification number | WA300996 | Number of Individuals Covered | 394 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $8,124 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $88,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,124 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFITS SERVICES, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 3 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 204 | Insurance policy start date | 2015-10-01 | Insurance policy end date | 2016-09-30 | Total amount of commissions paid to insurance broker | USD $1,331 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $27,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,331 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFITS SERVICES, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 400163291 |
Policy instance | 5 |
Insurance contract or identification number | 400163291 | Number of Individuals Covered | 286 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $3,960 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $26,400 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,960 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163290 |
Policy instance | 6 |
Insurance contract or identification number | 10163290 | Number of Individuals Covered | 354 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $2,567 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $25,672 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,567 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
Policy contract number | 10012655 |
Policy instance | 4 |
Insurance contract or identification number | 10012655 | Number of Individuals Covered | 516 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $35,881 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,304,629 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,881 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30010127 |
Policy instance | 3 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 206 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $1,260 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $25,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,260 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163289 |
Policy instance | 2 |
Insurance contract or identification number | 10163289 | Number of Individuals Covered | 354 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $467 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $4,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $467 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 1D024577 |
Policy instance | 1 |
Insurance contract or identification number | 1D024577 | Number of Individuals Covered | 340 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $17,867 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | 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 $178,668 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,867 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 400163291 |
Policy instance | 6 |
Insurance contract or identification number | 400163291 | Number of Individuals Covered | 287 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $4,612 | Total amount of fees paid to insurance company | USD $1,524 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | 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 $30,743 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,901 | Amount paid for insurance broker fees | 1524 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163290 |
Policy instance | 5 |
Insurance contract or identification number | 10163290 | Number of Individuals Covered | 296 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $2,543 | Total amount of fees paid to insurance company | USD $815 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $25,431 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,150 | Amount paid for insurance broker fees | 815 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163289 |
Policy instance | 4 |
Insurance contract or identification number | 10163289 | Number of Individuals Covered | 296 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $473 | Total amount of fees paid to insurance company | USD $154 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $4,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $404 | Amount paid for insurance broker fees | 154 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 197 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $1,333 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $27,561 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,140 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFIT SERVICES, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 1D024577 |
Policy instance | 3 |
Insurance contract or identification number | 1D024577 | Number of Individuals Covered | 274 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $21,094 | Total amount of fees paid to insurance company | USD $1,666 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | 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 $210,933 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,765 | Amount paid for insurance broker fees | 1666 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFITS SERVICES INC |
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REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
Policy contract number | 10012655 |
Policy instance | 2 |
Insurance contract or identification number | 10012655 | Number of Individuals Covered | 770 | Insurance policy start date | 2013-10-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $37,404 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,246,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,849 | Insurance broker organization code? | 3 | Insurance broker name | CAPITAL BENEFITS SERVICES INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 400163291 |
Policy instance | 6 |
Insurance contract or identification number | 400163291 | Number of Individuals Covered | 122 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $6,916 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | 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 $46,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,916 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163290 |
Policy instance | 5 |
Insurance contract or identification number | 10163290 | Number of Individuals Covered | 361 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $2,871 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $28,709 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,871 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10163289 |
Policy instance | 4 |
Insurance contract or identification number | 10163289 | Number of Individuals Covered | 360 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $536 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 $5,358 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $536 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 1D024577 |
Policy instance | 3 |
Insurance contract or identification number | 1D024577 | Number of Individuals Covered | 344 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $21,499 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | 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 $214,987 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,499 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY LLC |
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REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
Policy contract number | 10012655 |
Policy instance | 2 |
Insurance contract or identification number | 10012655 | Number of Individuals Covered | 903 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $86,026 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,606,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $86,026 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 ) |
Policy contract number | 30010127 |
Policy instance | 1 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 225 | Insurance policy start date | 2012-10-01 | Insurance policy end date | 2013-09-30 | Total amount of commissions paid to insurance broker | USD $1,402 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $29,879 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,402 | Insurance broker organization code? | 3 | Insurance broker name | BENEFIT ADMINISTRATION COMPANY, LLC |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 5435400 |
Policy instance | 3 |
Insurance contract or identification number | 5435400 | Number of Individuals Covered | 75 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $6,268 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $316,596 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 5672400 |
Policy instance | 4 |
Insurance contract or identification number | 5672400 | Number of Individuals Covered | 317 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $794,659 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 ) |
Policy contract number | 30010127 |
Policy instance | 6 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 202 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $1,355 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $28,314 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | P0129 |
Policy instance | 1 |
Insurance contract or identification number | P0129 | Number of Individuals Covered | 141 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $5,763 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $26,927 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 5435300 |
Policy instance | 5 |
Insurance contract or identification number | 5435300 | Number of Individuals Covered | 168 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $5,380 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $280,316 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5455106 |
Policy instance | 2 |
Insurance contract or identification number | 5455106 | Number of Individuals Covered | 347 | Insurance policy start date | 2011-10-01 | Insurance policy end date | 2012-09-30 | Total amount of commissions paid to insurance broker | USD $23,991 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $315,703 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 ) |
Policy contract number | 30010127 |
Policy instance | 4 |
Insurance contract or identification number | 30010127 | Number of Individuals Covered | 206 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $1,243 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | 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 $24,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 5435300 |
Policy instance | 3 |
Insurance contract or identification number | 5435300 | Number of Individuals Covered | 423 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $14,368 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $730,846 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 5435400 |
Policy instance | 2 |
Insurance contract or identification number | 5435400 | Number of Individuals Covered | 165 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $8,707 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $441,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5455106 |
Policy instance | 1 |
Insurance contract or identification number | 5455106 | Number of Individuals Covered | 303 | Insurance policy start date | 2010-10-01 | Insurance policy end date | 2011-09-30 | Total amount of commissions paid to insurance broker | USD $28,127 | Total amount of fees paid to insurance company | USD $6,170 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $261,536 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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