PEADEN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AMBIENT AIR LLC WELFARE BENEFIT PLAN
Measure | Date | Value |
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2022: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-12-01 | 199 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-12-01 | 233 |
Number of retired or separated participants receiving benefits | 2022-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-12-01 | 0 |
Total of all active and inactive participants | 2022-12-01 | 233 |
Number of employers contributing to the scheme | 2022-12-01 | 0 |
2021: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-12-01 | 242 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 199 |
Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
Total of all active and inactive participants | 2021-12-01 | 199 |
Number of employers contributing to the scheme | 2021-12-01 | 0 |
2020: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-12-01 | 257 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 242 |
Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
Total of all active and inactive participants | 2020-12-01 | 242 |
Number of employers contributing to the scheme | 2020-12-01 | 0 |
2019: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-12-01 | 252 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 257 |
Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
Total of all active and inactive participants | 2019-12-01 | 257 |
Number of employers contributing to the scheme | 2019-12-01 | 0 |
2018: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-12-01 | 253 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 252 |
Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
Total of all active and inactive participants | 2018-12-01 | 252 |
Number of employers contributing to the scheme | 2018-12-01 | 0 |
2017: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-12-01 | 327 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 253 |
Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
Total of all active and inactive participants | 2017-12-01 | 253 |
Number of employers contributing to the scheme | 2017-12-01 | 0 |
Total participants, beginning-of-year | 2017-01-01 | 327 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 257 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 257 |
Number of employers contributing to the scheme | 2017-01-01 | 0 |
2016: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 337 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 327 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 327 |
2015: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 337 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 337 |
2022: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2022 form 5500 responses |
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2022-12-01 | Type of plan entity | Single employer plan |
2022-12-01 | Plan funding arrangement – Insurance | Yes |
2022-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-12-01 | Plan benefit arrangement – Insurance | Yes |
2022-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2021 form 5500 responses |
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2021-12-01 | Type of plan entity | Single employer plan |
2021-12-01 | Plan funding arrangement – Insurance | Yes |
2021-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-12-01 | Plan benefit arrangement – Insurance | Yes |
2021-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2020 form 5500 responses |
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2020-12-01 | Type of plan entity | Single employer plan |
2020-12-01 | Plan funding arrangement – Insurance | Yes |
2020-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-12-01 | Plan benefit arrangement – Insurance | Yes |
2020-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2019 form 5500 responses |
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2019-12-01 | Type of plan entity | Single employer plan |
2019-12-01 | Submission has been amended | Yes |
2019-12-01 | Plan funding arrangement – Insurance | Yes |
2019-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-12-01 | Plan benefit arrangement – Insurance | Yes |
2019-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2018 form 5500 responses |
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2018-12-01 | Type of plan entity | Single employer plan |
2018-12-01 | Submission has been amended | Yes |
2018-12-01 | Plan funding arrangement – Insurance | Yes |
2018-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-12-01 | Plan benefit arrangement – Insurance | Yes |
2018-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2017 form 5500 responses |
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2017-12-01 | Type of plan entity | Single employer plan |
2017-12-01 | Submission has been amended | Yes |
2017-12-01 | Plan funding arrangement – Insurance | Yes |
2017-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-12-01 | Plan benefit arrangement – Insurance | Yes |
2017-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2016: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Submission has been amended | No |
2016-01-01 | This submission is the final filing | No |
2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-01-01 | Plan is a collectively bargained plan | No |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2015: AMBIENT AIR LLC WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Submission has been amended | No |
2015-01-01 | This submission is the final filing | No |
2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-01-01 | Plan is a collectively bargained plan | No |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL160513 |
Policy instance | 4 |
Insurance contract or identification number | GL160513 | Number of Individuals Covered | 233 | Insurance policy start date | 2022-12-01 | Insurance policy end date | 2023-11-30 | Total amount of commissions paid to insurance broker | USD $7,216 | Total amount of fees paid to insurance company | USD $1,322 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $72,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,216 | Amount paid for insurance broker fees | 889 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | D0586 |
Policy instance | 3 |
Insurance contract or identification number | D0586 | Number of Individuals Covered | 154 | Insurance policy start date | 2022-12-01 | Insurance policy end date | 2023-11-30 | Total amount of commissions paid to insurance broker | USD $80,542 | Total amount of fees paid to insurance company | USD $0 | Health 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 $80,542 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 922530 |
Policy instance | 1 |
Insurance contract or identification number | 922530 | Number of Individuals Covered | 115 | Insurance policy start date | 2022-12-01 | Insurance policy end date | 2023-11-30 | Total amount of commissions paid to insurance broker | USD $12,484 | Total amount of fees paid to insurance company | USD $502 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $104,032 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,484 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 889263G |
Policy instance | 2 |
Insurance contract or identification number | 889263G | Number of Individuals Covered | 87 | Insurance policy start date | 2022-12-01 | Insurance policy end date | 2023-11-30 | Total amount of commissions paid to insurance broker | USD $11,318 | Total amount of fees paid to insurance company | USD $755 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $40,119 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,318 | Amount paid for insurance broker fees | 755 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 922530 |
Policy instance | 1 |
Insurance contract or identification number | 922530 | Number of Individuals Covered | 296 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $10,411 | Total amount of fees paid to insurance company | USD $95 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $96,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,411 | Amount paid for insurance broker fees | 95 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 889263G |
Policy instance | 2 |
Insurance contract or identification number | 889263G | Number of Individuals Covered | 63 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $9,999 | Total amount of fees paid to insurance company | USD $897 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $39,993 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,999 | Amount paid for insurance broker fees | 897 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | D0586 |
Policy instance | 3 |
Insurance contract or identification number | D0586 | Number of Individuals Covered | 130 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $68,136 | Total amount of fees paid to insurance company | USD $0 | Health 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 $68,136 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD130815 |
Policy instance | 4 |
Insurance contract or identification number | LTD130815 | Number of Individuals Covered | 200 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $7,746 | Total amount of fees paid to insurance company | USD $1,079 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $77,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,746 | Amount paid for insurance broker fees | 1079 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 922530 |
Policy instance | 1 |
Insurance contract or identification number | 922530 | Number of Individuals Covered | 281 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $327,528 | Total amount of fees paid to insurance company | USD $63,948 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,194,838 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $316,817 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT, BONUS |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 889263G |
Policy instance | 2 |
Insurance contract or identification number | 889263G | Number of Individuals Covered | 64 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $13,108 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $52,432 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,108 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL160513 |
Policy instance | 3 |
Insurance contract or identification number | GL160513 | Number of Individuals Covered | 242 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $8,607 | Total amount of fees paid to insurance company | USD $1,304 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $86,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,607 | Amount paid for insurance broker fees | 1304 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | D0586 |
Policy instance | 1 |
Insurance contract or identification number | D0586 | Number of Individuals Covered | 161 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $69,971 | Total amount of fees paid to insurance company | USD $0 | Health 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 $69,971 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1085037 |
Policy instance | 2 |
Insurance contract or identification number | 1085037 | Number of Individuals Covered | 295 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $13,669 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $110,083 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,413 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL160513 |
Policy instance | 3 |
Insurance contract or identification number | GL160513 | Number of Individuals Covered | 257 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $9,977 | Total amount of fees paid to insurance company | USD $1,080 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $101,802 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,977 | Amount paid for insurance broker fees | 1080 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1085037 |
Policy instance | 2 |
Insurance contract or identification number | 1085037 | Number of Individuals Covered | 345 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $15,914 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $121,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,206 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | D0586 |
Policy instance | 1 |
Insurance contract or identification number | D0586 | Number of Individuals Covered | 202 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $62,095 | Total amount of fees paid to insurance company | USD $0 | Health 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 $62,095 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL160513 |
Policy instance | 4 |
Insurance contract or identification number | GL160513 | Number of Individuals Covered | 252 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $1,169 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $11,070 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,169 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05944040 |
Policy instance | 3 |
Insurance contract or identification number | TM05944040 | Number of Individuals Covered | 224 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $3,805 | Total amount of fees paid to insurance company | USD $333 | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $31,293 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,673 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD130815 |
Policy instance | 5 |
Insurance contract or identification number | LTD130815 | Number of Individuals Covered | 252 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $2,758 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,758 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5944040 |
Policy instance | 4 |
Insurance contract or identification number | 5944040 | Number of Individuals Covered | 189 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $2,654 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $18,882 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,654 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05944040 |
Policy instance | 3 |
Insurance contract or identification number | TM05944040 | Number of Individuals Covered | 253 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $3,628 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $39,075 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,628 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
Policy contract number | 1085037 |
Policy instance | 2 |
Insurance contract or identification number | 1085037 | Number of Individuals Covered | 368 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $21,620 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $124,841 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,479 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | D0586 |
Policy instance | 1 |
Insurance contract or identification number | D0586 | Number of Individuals Covered | 192 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $66,885 | Total amount of fees paid to insurance company | USD $0 | Health 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 $66,885 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA8122 |
Policy instance | 1 |
Insurance contract or identification number | GA8122 | Number of Individuals Covered | 245 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $48,712 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,355,181 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
Policy contract number | GA2632 |
Policy instance | 2 |
Insurance contract or identification number | GA2632 | Number of Individuals Covered | 257 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $2,491 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $24,562 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | 00 |
Policy instance | 3 |
Insurance contract or identification number | 00 | Number of Individuals Covered | 257 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GA8122 |
Policy instance | 4 |
Insurance contract or identification number | GA8122 | Number of Individuals Covered | 285 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-11-30 | Total amount of commissions paid to insurance broker | USD $775 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,570 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 ) |
Policy contract number | GA2632 |
Policy instance | 2 |
Insurance contract or identification number | GA2632 | Number of Individuals Covered | 340 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $2,729 | 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 | 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 $44,011 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,784 | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS PLANNING CORP |
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BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | 544103 |
Policy instance | 1 |
Insurance contract or identification number | 544103 | Number of Individuals Covered | 249 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $9,712 | 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 $97,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,712 | Insurance broker organization code? | 3 | Insurance broker name | POINTENORTH INSURANCE GROUP LLC |
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