REGENSTRIEF INSTITUTE INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN
401k plan membership statisitcs for REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN
| Measure | Date | Value |
|---|
| 2023: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 158 |
| Total of all active and inactive participants | 2023-01-01 | 158 |
| Total participants | 2023-01-01 | 158 |
| 2022: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 149 |
| Total of all active and inactive participants | 2022-01-01 | 149 |
| Total participants | 2022-01-01 | 149 |
| 2021: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 154 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 3 |
| Total of all active and inactive participants | 2021-01-01 | 157 |
| Total participants | 2021-01-01 | 157 |
| 2020: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 161 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 163 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 3 |
| Total of all active and inactive participants | 2020-07-01 | 166 |
| Total participants | 2020-07-01 | 166 |
| 2019: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 159 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 1 |
| Total of all active and inactive participants | 2019-07-01 | 160 |
| Total participants | 2019-07-01 | 160 |
| 2018: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 155 |
| Total of all active and inactive participants | 2018-07-01 | 155 |
| Total participants | 2018-07-01 | 155 |
| 2017: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 132 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 1 |
| Total of all active and inactive participants | 2017-07-01 | 133 |
| Total participants | 2017-07-01 | 133 |
| 2016: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 116 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 4 |
| Total of all active and inactive participants | 2016-07-01 | 120 |
| Total participants | 2016-07-01 | 120 |
| 2015: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 141 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 1 |
| Total of all active and inactive participants | 2015-07-01 | 142 |
| Total participants | 2015-07-01 | 142 |
| 2014: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 120 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 4 |
| Total of all active and inactive participants | 2014-07-01 | 124 |
| Total participants | 2014-07-01 | 124 |
| 2013: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 130 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 4 |
| Total of all active and inactive participants | 2013-07-01 | 134 |
| Total participants | 2013-07-01 | 134 |
| 2012: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 131 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 2 |
| Total of all active and inactive participants | 2012-07-01 | 133 |
| Total participants | 2012-07-01 | 133 |
| 2011: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 137 |
| Total of all active and inactive participants | 2011-07-01 | 137 |
| Total participants | 2011-07-01 | 137 |
| 2009: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 128 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 1 |
| Total of all active and inactive participants | 2009-07-01 | 129 |
| Total participants | 2009-07-01 | 129 |
| 2023: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: REGENSTRIEF INSTITUTE INC HEALTH, VISION, DENTAL & FLEX SPENDING PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | First time form 5500 has been submitted | Yes |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $11,271 | | Total amount of fees paid to insurance company | USD $2,739 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $108,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $5,612 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | W10170 |
| Policy instance | 1 |
| Insurance contract or identification number | W10170 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $31,998 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,006,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,281 | | Total amount of fees paid to insurance company | USD $2,804 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,281 | | Amount paid for insurance broker fees | 2804 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,605 | | 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 $5,605 | | Insurance broker organization code? | 3 |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | W10170 |
| Policy instance | 1 |
| Insurance contract or identification number | W10170 | | Number of Individuals Covered | 264 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,891 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,933,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,618 | | Insurance broker organization code? | 3 |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $33,000 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,068,569 | | Commission paid to Insurance Broker | USD $33,000 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,913 | | 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 $5,913 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,932 | | Total amount of fees paid to insurance company | USD $2,725 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,932 | | Amount paid for insurance broker fees | 2725 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $51,671 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,975,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,861 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,757 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,757 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,600 | | 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 $4,260 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 1 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $11,066 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $105,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,525 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $8,208 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,208 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 285 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $5,034 | | Total amount of fees paid to insurance company | USD $180 | | 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 $5,034 | | Amount paid for insurance broker fees | 180 | | Additional information about fees paid to insurance broker | NEW BUSINESS BONUS | | Insurance broker organization code? | 3 |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | W10170 |
| Policy instance | 1 |
| Insurance contract or identification number | W10170 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $30,254 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,680,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,254 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $7,019 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $5,962 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $31,162 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,410,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $31,547 | | Total amount of fees paid to insurance company | USD $262 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,495,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,547 | | Amount paid for insurance broker fees | 262 | | Additional information about fees paid to insurance broker | BONUS, OVERRIDE, NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $4,862 | | 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 $4,862 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1054702 |
| Policy instance | 3 |
| Insurance contract or identification number | 1054702 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $7,330 | | Total amount of fees paid to insurance company | USD $686 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $62,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,330 | | Amount paid for insurance broker fees | 686 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY, INC. |
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| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $31,362 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,543,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,362 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $5,109 | | 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 $5,109 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2003-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $28,245 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,785,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,245 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 ) |
| Policy contract number | 30020229 |
| Policy instance | 3 |
| Insurance contract or identification number | 30020229 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $975 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $975 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY, INC. |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $5,160 | | 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 $5,160 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $5,193 | | 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 $5,193 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 ) |
| Policy contract number | 30020229 |
| Policy instance | 3 |
| Insurance contract or identification number | 30020229 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $990 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $990 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY, INC. |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $28,539 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,771,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,539 | | Insurance broker organization code? | 3 | | Insurance broker name | ERTEL & COMPANY |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 ) |
| Policy contract number | 30020229 |
| Policy instance | 3 |
| Insurance contract or identification number | 30020229 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $971 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $4,739 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $26,943 | | Total amount of fees paid to insurance company | USD $371 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,468,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 ) |
| Policy contract number | 00103450 |
| Policy instance | 1 |
| Insurance contract or identification number | 00103450 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $25,746 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,354,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GREAT LAKES DELTA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90301 ) |
| Policy contract number | 63 |
| Policy instance | 2 |
| Insurance contract or identification number | 63 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $4,525 | | 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 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 ) |
| Policy contract number | 30020229 |
| Policy instance | 3 |
| Insurance contract or identification number | 30020229 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $978 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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