RONALD COHN, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SPROUTS FARMERS MARKET DENTAL PLAN
| Measure | Date | Value |
|---|
| 2022: SPROUTS FARMERS MARKET DENTAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 0 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: SPROUTS FARMERS MARKET DENTAL 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 | 152 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 152 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2019: SPROUTS FARMERS MARKET DENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 171 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 171 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: SPROUTS FARMERS MARKET DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 205 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 205 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: SPROUTS FARMERS MARKET DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 189 |
| 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 | 189 |
| Number of employers contributing to the scheme | 2017-01-01 | 0 |
| 2016: SPROUTS FARMERS MARKET DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 189 |
| 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 | 189 |
| Number of employers contributing to the scheme | 2016-01-01 | 0 |
| 2015: SPROUTS FARMERS MARKET DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 113 |
| 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 | 113 |
| Number of employers contributing to the scheme | 2015-01-01 | 0 |
| 2014: SPROUTS FARMERS MARKET DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 114 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 114 |
| Number of employers contributing to the scheme | 2014-01-01 | 0 |
| 2013: SPROUTS FARMERS MARKET DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 91 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 94 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 94 |
| Number of employers contributing to the scheme | 2013-01-01 | 0 |
| 2012: SPROUTS FARMERS MARKET DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 87 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 91 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 91 |
| Number of employers contributing to the scheme | 2012-01-01 | 0 |
| 2011: SPROUTS FARMERS MARKET DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 87 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 87 |
| Number of employers contributing to the scheme | 2011-01-01 | 0 |
| 2010: SPROUTS FARMERS MARKET DENTAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 118 |
| Number of employers contributing to the scheme | 2010-01-01 | 0 |
| 2009: SPROUTS FARMERS MARKET DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 100 |
| Number of employers contributing to the scheme | 2009-01-01 | 0 |
| 2008: SPROUTS FARMERS MARKET DENTAL PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2008-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-01-01 | 0 |
| Total of all active and inactive participants | 2008-01-01 | 100 |
| Number of employers contributing to the scheme | 2008-01-01 | 0 |
| 2007: SPROUTS FARMERS MARKET DENTAL PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2007-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-01-01 | 0 |
| Total of all active and inactive participants | 2007-01-01 | 100 |
| Number of employers contributing to the scheme | 2007-01-01 | 0 |
| 2006: SPROUTS FARMERS MARKET DENTAL PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2006-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-01-01 | 0 |
| Total of all active and inactive participants | 2006-01-01 | 100 |
| Number of employers contributing to the scheme | 2006-01-01 | 0 |
| 2005: SPROUTS FARMERS MARKET DENTAL PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2005-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-01-01 | 0 |
| Total of all active and inactive participants | 2005-01-01 | 100 |
| Number of employers contributing to the scheme | 2005-01-01 | 0 |
| 2004: SPROUTS FARMERS MARKET DENTAL PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2004-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-01-01 | 0 |
| Total of all active and inactive participants | 2004-01-01 | 100 |
| Number of employers contributing to the scheme | 2004-01-01 | 0 |
| 2003: SPROUTS FARMERS MARKET DENTAL PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2003-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-01-01 | 0 |
| Total of all active and inactive participants | 2003-01-01 | 100 |
| Number of employers contributing to the scheme | 2003-01-01 | 0 |
| 2002: SPROUTS FARMERS MARKET DENTAL PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2002-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-01-01 | 0 |
| Total of all active and inactive participants | 2002-01-01 | 100 |
| Number of employers contributing to the scheme | 2002-01-01 | 0 |
| 2001: SPROUTS FARMERS MARKET DENTAL PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2001-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2001-01-01 | 0 |
| Total of all active and inactive participants | 2001-01-01 | 100 |
| Number of employers contributing to the scheme | 2001-01-01 | 0 |
| 2000: SPROUTS FARMERS MARKET DENTAL PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2000-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2000-01-01 | 0 |
| Total of all active and inactive participants | 2000-01-01 | 100 |
| Number of employers contributing to the scheme | 2000-01-01 | 0 |
| 1999: SPROUTS FARMERS MARKET DENTAL PLAN 1999 401k membership |
|---|
| Total participants, beginning-of-year | 1999-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 1999-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 1999-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1999-01-01 | 0 |
| Total of all active and inactive participants | 1999-01-01 | 100 |
| Number of employers contributing to the scheme | 1999-01-01 | 0 |
| 1998: SPROUTS FARMERS MARKET DENTAL PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 1998-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1998-01-01 | 0 |
| Total of all active and inactive participants | 1998-01-01 | 100 |
| Number of employers contributing to the scheme | 1998-01-01 | 0 |
| 1997: SPROUTS FARMERS MARKET DENTAL PLAN 1997 401k membership |
|---|
| Total participants, beginning-of-year | 1997-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 1997-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 1997-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1997-01-01 | 0 |
| Total of all active and inactive participants | 1997-01-01 | 100 |
| Number of employers contributing to the scheme | 1997-01-01 | 0 |
| 1996: SPROUTS FARMERS MARKET DENTAL PLAN 1996 401k membership |
|---|
| Total participants, beginning-of-year | 1996-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 1996-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 1996-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1996-01-01 | 0 |
| Total of all active and inactive participants | 1996-01-01 | 100 |
| Number of employers contributing to the scheme | 1996-01-01 | 0 |
| 2022: SPROUTS FARMERS MARKET DENTAL PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | This submission is the final filing | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SPROUTS FARMERS MARKET DENTAL 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 benefit arrangement – Insurance | Yes |
| 2019: SPROUTS FARMERS MARKET DENTAL PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: SPROUTS FARMERS MARKET DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SPROUTS FARMERS MARKET DENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SPROUTS FARMERS MARKET DENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: SPROUTS FARMERS MARKET DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: SPROUTS FARMERS MARKET DENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: SPROUTS FARMERS MARKET DENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: SPROUTS FARMERS MARKET DENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: SPROUTS FARMERS MARKET DENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: SPROUTS FARMERS MARKET DENTAL PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SPROUTS FARMERS MARKET DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: SPROUTS FARMERS MARKET DENTAL PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: SPROUTS FARMERS MARKET DENTAL PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: SPROUTS FARMERS MARKET DENTAL PLAN 2006 form 5500 responses |
|---|
| 2006-01-01 | Type of plan entity | Single employer plan |
| 2006-01-01 | Plan funding arrangement – Insurance | Yes |
| 2006-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: SPROUTS FARMERS MARKET DENTAL PLAN 2005 form 5500 responses |
|---|
| 2005-01-01 | Type of plan entity | Single employer plan |
| 2005-01-01 | Plan funding arrangement – Insurance | Yes |
| 2005-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: SPROUTS FARMERS MARKET DENTAL PLAN 2004 form 5500 responses |
|---|
| 2004-01-01 | Type of plan entity | Single employer plan |
| 2004-01-01 | Plan funding arrangement – Insurance | Yes |
| 2004-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: SPROUTS FARMERS MARKET DENTAL PLAN 2003 form 5500 responses |
|---|
| 2003-01-01 | Type of plan entity | Single employer plan |
| 2003-01-01 | Plan funding arrangement – Insurance | Yes |
| 2003-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: SPROUTS FARMERS MARKET DENTAL PLAN 2002 form 5500 responses |
|---|
| 2002-01-01 | Type of plan entity | Single employer plan |
| 2002-01-01 | Plan funding arrangement – Insurance | Yes |
| 2002-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: SPROUTS FARMERS MARKET DENTAL PLAN 2001 form 5500 responses |
|---|
| 2001-01-01 | Type of plan entity | Single employer plan |
| 2001-01-01 | Plan funding arrangement – Insurance | Yes |
| 2001-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2000: SPROUTS FARMERS MARKET DENTAL PLAN 2000 form 5500 responses |
|---|
| 2000-01-01 | Type of plan entity | Single employer plan |
| 2000-01-01 | Plan funding arrangement – Insurance | Yes |
| 2000-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1999: SPROUTS FARMERS MARKET DENTAL PLAN 1999 form 5500 responses |
|---|
| 1999-01-01 | Type of plan entity | Single employer plan |
| 1999-01-01 | Plan funding arrangement – Insurance | Yes |
| 1999-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1998: SPROUTS FARMERS MARKET DENTAL PLAN 1998 form 5500 responses |
|---|
| 1998-01-01 | Type of plan entity | Single employer plan |
| 1998-01-01 | Plan funding arrangement – Insurance | Yes |
| 1998-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1997: SPROUTS FARMERS MARKET DENTAL PLAN 1997 form 5500 responses |
|---|
| 1997-01-01 | Type of plan entity | Single employer plan |
| 1997-01-01 | Plan funding arrangement – Insurance | Yes |
| 1997-01-01 | Plan benefit arrangement – Insurance | Yes |
| 1996: SPROUTS FARMERS MARKET DENTAL PLAN 1996 form 5500 responses |
|---|
| 1996-01-01 | Type of plan entity | Single employer plan |
| 1996-01-01 | First time form 5500 has been submitted | Yes |
| 1996-01-01 | Plan funding arrangement – Insurance | Yes |
| 1996-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 924405 |
| Policy instance | 1 |
| Insurance contract or identification number | 924405 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $4,588 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $439,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,588 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 279579 |
| Policy instance | 2 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $8,580 | | Total amount of fees paid to insurance company | USD $1,579 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $509,077 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,514 | | Amount paid for insurance broker fees | 1579 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 279579 |
| Policy instance | 1 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | 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 | | 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 $67,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 279579 |
| Policy instance | 2 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $33,342 | | Total amount of fees paid to insurance company | USD $172 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $535,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,878 | | Amount paid for insurance broker fees | 172 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 279579 |
| Policy instance | 1 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | 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 | | 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 $66,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 279579 |
| Policy instance | 1 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | 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 | | 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 $63,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 279579 |
| Policy instance | 1 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | 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 | | 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 $73,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 279579 |
| Policy instance | 1 |
| Insurance contract or identification number | 279579 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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 | | 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 $73,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 475881 |
| Policy instance | 1 |
| Insurance contract or identification number | 475881 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $5,390 | | 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 $51,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,037 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 475881 |
| Policy instance | 1 |
| Insurance contract or identification number | 475881 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $5,523 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $52,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,523 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 475881 |
| Policy instance | 1 |
| Insurance contract or identification number | 475881 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $3,731 | | Total amount of fees paid to insurance company | USD $877 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,515 | | Amount paid for insurance broker fees | 877 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 475881 |
| Policy instance | 3 |
| Insurance contract or identification number | 475881 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $929 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $864 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| CALIFORNIA BENEFITS DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1476 |
| Policy instance | 2 |
| Insurance contract or identification number | 1476 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $781 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $781 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $1,983 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,983 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| CALIFORNIA BENEFITS DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 1476 |
| Policy instance | 2 |
| Insurance contract or identification number | 1476 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $841 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,415 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $841 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $2,714 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,714 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $2,322 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,322 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2008-06-01 | | Insurance policy end date | 2009-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2007-06-01 | | Insurance policy end date | 2008-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2006-06-01 | | Insurance policy end date | 2007-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2005-06-01 | | Insurance policy end date | 2006-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2004-06-01 | | Insurance policy end date | 2005-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2003-06-01 | | Insurance policy end date | 2004-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2002-06-01 | | Insurance policy end date | 2003-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2001-06-01 | | Insurance policy end date | 2002-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2000-06-01 | | Insurance policy end date | 2001-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 1999-06-01 | | Insurance policy end date | 2000-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 1998-06-01 | | Insurance policy end date | 1999-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 1997-06-01 | | Insurance policy end date | 1998-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 1996-06-01 | | Insurance policy end date | 1997-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 425760 |
| Policy instance | 1 |
| Insurance contract or identification number | 425760 | | Number of Individuals Covered | 100 | | Insurance policy start date | 1995-06-01 | | Insurance policy end date | 1996-05-31 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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