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TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 401k Plan overview

Plan NameTRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301
Plan identification number 501

TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TRIANA SERVICES COMPANY, LLC/ TRIANA ENERGY HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name:TRIANA SERVICES COMPANY, LLC/ TRIANA ENERGY HOLDINGS, LLC
Employer identification number (EIN):264486686
NAIC Classification:541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01ED LINCOLN
5012011-01-01ED LINCOLN
5012009-01-01ED LINCOLN ED LINCOLN2010-10-15

Plan Statistics for TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301

401k plan membership statisitcs for TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301

Measure Date Value
2016: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2016 401k membership
Total participants, beginning-of-year2016-01-01100
Total number of active participants reported on line 7a of the Form 55002016-01-0155
Total of all active and inactive participants2016-01-0155
2015: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2015 401k membership
Total participants, beginning-of-year2015-01-01266
Total number of active participants reported on line 7a of the Form 55002015-01-01100
Total of all active and inactive participants2015-01-01100
2014: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2014 401k membership
Total participants, beginning-of-year2014-01-01233
Total number of active participants reported on line 7a of the Form 55002014-01-01266
Total of all active and inactive participants2014-01-01266
2013: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2013 401k membership
Total participants, beginning-of-year2013-01-01225
Total number of active participants reported on line 7a of the Form 55002013-01-01233
Total of all active and inactive participants2013-01-01233
2012: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2012 401k membership
Total participants, beginning-of-year2012-01-01339
Total number of active participants reported on line 7a of the Form 55002012-01-01225
Total of all active and inactive participants2012-01-01225
2011: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2011 401k membership
Total participants, beginning-of-year2011-01-01329
Total number of active participants reported on line 7a of the Form 55002011-01-01339
Total of all active and inactive participants2011-01-01339
2009: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2009 401k membership
Total participants, beginning-of-year2009-01-01272
Total number of active participants reported on line 7a of the Form 55002009-01-01365
Total of all active and inactive participants2009-01-01365

Form 5500 Responses for TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301

2016: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: TRIANA SERVICES COMPANY,LLC EMPLOYEE BENEFIT PLAN 900 VIRGINIA STREET, EAST CHARLESTON, WV 25301 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered129
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $26,563
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $197,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,783
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number1661 & 1558
Policy instance 5
Insurance contract or identification number1661 & 1558
Number of Individuals Covered291
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $379
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $7,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $379
Insurance broker organization code?3
Insurance broker name
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered117
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,307
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $769
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number05778
Policy instance 3
Insurance contract or identification number05778
Number of Individuals Covered106
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $4,290
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,290
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered100
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $48,217
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,187,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $78,829
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER ALLEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered254
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,348
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,348
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number05778
Policy instance 3
Insurance contract or identification number05778
Number of Individuals Covered265
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $7,414
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,414
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered266
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $159,091
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,634,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125,830
Insurance broker organization code?3
Insurance broker nameEMERSON REIS LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered258
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,688
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $256,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,688
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number1661 & 1558
Policy instance 5
Insurance contract or identification number1661 & 1558
Number of Individuals Covered207
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $368
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $8,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $216
Insurance broker organization code?3
Insurance broker nameUSI INS SERVICES LLC
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number1661 & 1558
Policy instance 5
Insurance contract or identification number1661 & 1558
Number of Individuals Covered215
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $330
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $330
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered238
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $1,814
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,814
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered233
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $76,782
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,384,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,782
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered227
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $19,173
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $200,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,173
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number05778
Policy instance 3
Insurance contract or identification number05778
Number of Individuals Covered246
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $6,174
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,174
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered246
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $24,444
Total amount of fees paid to insurance companyUSD $3,174
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $235,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,444
Amount paid for insurance broker fees3174
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number
Policy instance 5
Number of Individuals Covered215
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $330
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $330
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered313
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $2,149
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,149
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number05778
Policy instance 3
Insurance contract or identification number05778
Number of Individuals Covered326
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $8,988
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $179,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,988
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered225
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $109,317
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,047,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $109,317
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS OF WV INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered352
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,096
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract number05778
Policy instance 3
Insurance contract or identification number05778
Number of Individuals Covered365
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $8,773
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered339
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $118,438
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,331,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered379
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $17,107
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $180,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number
Policy instance 5
Number of Individuals Covered328
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $504
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $10,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30000578
Policy instance 4
Insurance contract or identification number30000578
Number of Individuals Covered326
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $2,150
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )
Policy contract number103012
Policy instance 2
Insurance contract or identification number103012
Number of Individuals Covered329
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $123,861
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,424,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number855318G
Policy instance 1
Insurance contract or identification number855318G
Number of Individuals Covered369
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,673
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 )
Policy contract numberWV05778
Policy instance 3
Insurance contract or identification numberWV05778
Number of Individuals Covered398
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $10,360
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $207,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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