TCAG, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN
401k plan membership statisitcs for TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2023: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 554 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 526 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 526 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2022: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 636 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 554 |
| 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 | 554 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 648 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 636 |
| 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 | 636 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 617 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 636 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 648 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 704 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 607 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 10 |
| 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 | 617 |
| 2018: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 734 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 693 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 11 |
| 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 | 704 |
| 2017: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 743 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 734 |
| 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 | 734 |
| 2016: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 788 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 739 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 4 |
| 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 | 743 |
| 2015: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 740 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 788 |
| Total of all active and inactive participants | 2015-01-01 | 788 |
| Total participants | 2015-01-01 | 0 |
| 2014: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 672 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 740 |
| Total of all active and inactive participants | 2014-01-01 | 740 |
| Total participants | 2014-01-01 | 0 |
| 2013: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 685 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 672 |
| Total of all active and inactive participants | 2013-01-01 | 672 |
| Total participants | 2013-01-01 | 0 |
| 2012: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 704 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 685 |
| Total of all active and inactive participants | 2012-01-01 | 685 |
| Total participants | 2012-01-01 | 0 |
| 2011: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 708 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 704 |
| Total of all active and inactive participants | 2011-01-01 | 704 |
| Total participants | 2011-01-01 | 704 |
| 2009: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 758 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 701 |
| Total of all active and inactive participants | 2009-10-01 | 701 |
| Total participants | 2009-10-01 | 701 |
| 2023: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS 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 |
| 2009: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: TUTTLE-CLICK AUTOMOTIVE GROUP FLEXIBLE BENEFITS PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0BB3P |
| Policy instance | 2 |
| Insurance contract or identification number | GUC0BB3P | | Number of Individuals Covered | 533 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $94,505 | | Total amount of fees paid to insurance company | USD $37,505 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $630,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 138372 |
| Policy instance | 1 |
| Insurance contract or identification number | 138372 | | Number of Individuals Covered | 1236 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $44,403 | | Total amount of fees paid to insurance company | USD $10,000 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $506,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC0BB3P |
| Policy instance | 3 |
| Insurance contract or identification number | GUC0BB3P | | Number of Individuals Covered | 554 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $89,296 | | Total amount of fees paid to insurance company | USD $34,897 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $597,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $89,296 | | Amount paid for insurance broker fees | 34897 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 36533 |
| Policy instance | 2 |
| Insurance contract or identification number | 36533 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $19,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 138372 |
| Policy instance | 1 |
| Insurance contract or identification number | 138372 | | Number of Individuals Covered | 1271 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $45,770 | | Total amount of fees paid to insurance company | USD $10,721 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $513,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,770 | | Amount paid for insurance broker fees | 10721 | | Additional information about fees paid to insurance broker | 2021 SIGNATURE DENTAL RETENTION INCENTIVE RISK, INDIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0BB3P |
| Policy instance | 2 |
| Insurance contract or identification number | GVTL0BB3P | | Number of Individuals Covered | 598 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $90,286 | | Total amount of fees paid to insurance company | USD $37,423 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $601,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $90,286 | | Amount paid for insurance broker fees | 37423 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 138372 |
| Policy instance | 1 |
| Insurance contract or identification number | 138372 | | Number of Individuals Covered | 1349 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $53,781 | | Total amount of fees paid to insurance company | USD $12,018 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $495,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,781 | | Amount paid for insurance broker fees | 12018 | | Additional information about fees paid to insurance broker | 2020 Q4 SIGNATURE SPECIALTY NEW BUSINESS INCENTIVE RISK AND INDIRECT COMPENSATION | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 138372 |
| Policy instance | 1 |
| Insurance contract or identification number | 138372 | | Number of Individuals Covered | 1440 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $42,776 | | Total amount of fees paid to insurance company | USD $23,775 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $490,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,776 | | Amount paid for insurance broker fees | 23775 | | Additional information about fees paid to insurance broker | 2020 Q1 BANNER HEALTH JOINT VENTURE BONUS-MEDICAL | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0BB3P |
| Policy instance | 2 |
| Insurance contract or identification number | GVTL0BB3P | | Number of Individuals Covered | 641 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $97,289 | | Total amount of fees paid to insurance company | USD $21,730 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $648,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97,289 | | Amount paid for insurance broker fees | 21730 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0BB3P |
| Policy instance | 5 |
| Insurance contract or identification number | GUPR0BB3P | | Number of Individuals Covered | 350 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $22,368 | | Total amount of fees paid to insurance company | USD $4,342 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,368 | | Amount paid for insurance broker fees | 4342 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0BB3P |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0BB3P | | Number of Individuals Covered | 633 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $35,512 | | Total amount of fees paid to insurance company | USD $6,776 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $236,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,512 | | Amount paid for insurance broker fees | 6776 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0BB3P |
| Policy instance | 3 |
| Insurance contract or identification number | GUC 0BB3P | | Number of Individuals Covered | 613 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $26,494 | | Total amount of fees paid to insurance company | USD $4,850 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $176,814 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,494 | | Amount paid for insurance broker fees | 4850 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0BB3P |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0BB3P | | Number of Individuals Covered | 21 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $6,892 | | Total amount of fees paid to insurance company | USD $881 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,892 | | Amount paid for insurance broker fees | 881 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 1 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $42,960 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $423,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,960 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 1 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $38,490 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $374,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,490 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0BB3P |
| Policy instance | 2 |
| Insurance contract or identification number | GLTD0BB3P | | Number of Individuals Covered | 9 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,312 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,312 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUC 0BB3P |
| Policy instance | 3 |
| Insurance contract or identification number | GUC 0BB3P | | Number of Individuals Covered | 523 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,085 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $140,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,085 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GVTL0BB3P |
| Policy instance | 4 |
| Insurance contract or identification number | GVTL0BB3P | | Number of Individuals Covered | 618 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $30,775 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $205,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,775 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPR0BB3P |
| Policy instance | 5 |
| Insurance contract or identification number | GUPR0BB3P | | Number of Individuals Covered | 325 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $18,395 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,395 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 1 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $31,367 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $367,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,367 | | Insurance broker organization code? | 3 | | Insurance broker name | DULEY-BOLWAR & ASSOCIATES INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000403002718 |
| Policy instance | 2 |
| Insurance contract or identification number | 000403002718 | | Number of Individuals Covered | 437 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,609 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,403 | | Insurance broker organization code? | 3 | | Insurance broker name | SRA INSURANCE AGENCY LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 3 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,775 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,427 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,422 | | Insurance broker organization code? | 3 | | Insurance broker name | D M L JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010183200 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010183200 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $18,403 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,906 | | Insurance broker organization code? | 3 | | Insurance broker name | SRA INSURANCE AGENCY LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 400001000 17615 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000 17615 | | Number of Individuals Covered | 624 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $32,741 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $218,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,748 | | Insurance broker organization code? | 3 | | Insurance broker name | SRA INSURANCE AGENCY LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 000010183199 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010183199 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $22,437 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,599 | | Insurance broker organization code? | 3 | | Insurance broker name | SRA INSURANCE AGENCY LLC |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-003 |
| Policy instance | 5 |
| Insurance contract or identification number | 897200-003 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,214 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $7,214 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-299 |
| Policy instance | 4 |
| Insurance contract or identification number | 897200-299 | | Number of Individuals Covered | 370 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $12,732 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $12,732 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 3 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 1291 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 17031, 17032 |
| Policy instance | 2 |
| Insurance contract or identification number | 17031, 17032 | | Number of Individuals Covered | 711 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,589 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PRE-PAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,589 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,611 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,611 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183199 |
| Policy instance | 9 |
| Insurance contract or identification number | 10183199 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $20,057 | | Are there contracts with allocated funds for individual policies? | Yes | | Long Term Disability 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 $20,057 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 403002718 |
| Policy instance | 7 |
| Insurance contract or identification number | 403002718 | | Number of Individuals Covered | 545 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,055 | | Are there contracts with allocated funds for individual policies? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,055 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 40000100 |
| Policy instance | 8 |
| Insurance contract or identification number | 40000100 | | Number of Individuals Covered | 888 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $28,491 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $28,491 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 897200-199 |
| Policy instance | 6 |
| Insurance contract or identification number | 897200-199 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,470 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $2,470 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183200 |
| Policy instance | 10 |
| Insurance contract or identification number | 10183200 | | Number of Individuals Covered | 387 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $15,562 | | Are there contracts with allocated funds for individual policies? | Yes | | Unemployment 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 $15,562 | | Insurance broker organization code? | 3 | | Insurance broker name | DML JR INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183200 |
| Policy instance | 11 |
| Insurance contract or identification number | 10183200 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $14,813 | | Total amount of fees paid to insurance company | USD $2,875 | | Are there contracts with allocated funds for individual policies? | Yes | | Unemployment 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 $14,813 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2875 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | DULEY BOLWAR INS AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 10183199 |
| Policy instance | 10 |
| Insurance contract or identification number | 10183199 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $18,720 | | Total amount of fees paid to insurance company | USD $3,393 | | Are there contracts with allocated funds for individual policies? | Yes | | Long Term Disability 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 $18,720 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3393 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | DULEY BOLWAR INS AGENCY |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-003 |
| Policy instance | 6 |
| Insurance contract or identification number | 897200-003 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,065 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $8,065 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 17031, 17032 |
| Policy instance | 2 |
| Insurance contract or identification number | 17031, 17032 | | Number of Individuals Covered | 681 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,324 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PRE-PAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,324 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 3334433 |
| Policy instance | 4 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $3,366 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,366 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 3 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 1271 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,772 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,772 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-299 |
| Policy instance | 5 |
| Insurance contract or identification number | 897200-299 | | Number of Individuals Covered | 330 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $11,024 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $11,024 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 40000100 |
| Policy instance | 9 |
| Insurance contract or identification number | 40000100 | | Number of Individuals Covered | 794 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $23,517 | | Total amount of fees paid to insurance company | USD $4,354 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $23,517 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4354 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | DULEY BOLWAR INS AGENCY |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 ) |
| Policy contract number | 403002718 |
| Policy instance | 8 |
| Insurance contract or identification number | 403002718 | | Number of Individuals Covered | 486 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,896 | | Total amount of fees paid to insurance company | USD $341 | | Are there contracts with allocated funds for individual policies? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,896 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 341 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker name | DULEY BOLWAR INS AGENCY |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 897200-199 |
| Policy instance | 7 |
| Insurance contract or identification number | 897200-199 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,580 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $2,580 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 3334433 |
| Policy instance | 4 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-01-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,328 | | 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 $20,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,328 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-003 |
| Policy instance | 6 |
| Insurance contract or identification number | 897200-003 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,937 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $6,937 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 17031, 17032 |
| Policy instance | 2 |
| Insurance contract or identification number | 17031, 17032 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,223 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PRE-PAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,223 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 145702 |
| Policy instance | 8 |
| Insurance contract or identification number | 145702 | | Number of Individuals Covered | 339 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $16,888 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $16,888 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3334433 |
| Policy instance | 3 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 1205 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-299 |
| Policy instance | 5 |
| Insurance contract or identification number | 897200-299 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $9,937 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $9,937 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 897200-199 |
| Policy instance | 7 |
| Insurance contract or identification number | 897200-199 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,048 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $2,048 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 145703 |
| Policy instance | 9 |
| Insurance contract or identification number | 145703 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $14,977 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $14,977 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | C19474 |
| Policy instance | 10 |
| Insurance contract or identification number | C19474 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $847 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $847 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 9 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,002 | | 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 $33,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,002 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 17031, 17032 |
| Policy instance | 8 |
| Insurance contract or identification number | 17031, 17032 | | Number of Individuals Covered | 710 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $4,058 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PRE-PAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,058 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3334433 |
| Policy instance | 7 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 1264 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-299 |
| Policy instance | 5 |
| Insurance contract or identification number | 897200-299 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,956 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $6,956 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 897200-003 |
| Policy instance | 4 |
| Insurance contract or identification number | 897200-003 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,816 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $5,816 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 897200-199 |
| Policy instance | 3 |
| Insurance contract or identification number | 897200-199 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,113 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $2,113 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 145702 |
| Policy instance | 2 |
| Insurance contract or identification number | 145702 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $8,775 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $8,775 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 3305632 |
| Policy instance | 6 |
| Insurance contract or identification number | 3305632 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $13,194 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,194 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 145703 |
| Policy instance | 1 |
| Insurance contract or identification number | 145703 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $9,336 | | Are there contracts with allocated funds for individual policies? | Yes | | Life 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 $9,336 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 4 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,779 | | 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 $77,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 527524 |
| Policy instance | 3 |
| Insurance contract or identification number | 527524 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,112 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1016093 |
| Policy instance | 2 |
| Insurance contract or identification number | 1016093 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,263 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3334433 |
| Policy instance | 1 |
| Insurance contract or identification number | 3334433 | | Number of Individuals Covered | 1383 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | C19474 |
| Policy instance | 5 |
| Insurance contract or identification number | C19474 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,692 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 715471 |
| Policy instance | 2 |
| Insurance contract or identification number | 715471 | | Number of Individuals Covered | 1250 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $25,422 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,422 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | U5338 & U581 |
| Policy instance | 7 |
| Insurance contract or identification number | U5338 & U581 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $868 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $868 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 17031 |
| Policy instance | 6 |
| Insurance contract or identification number | 17031 | | Number of Individuals Covered | 949 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,327 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $1,327 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | C19474 |
| Policy instance | 5 |
| Insurance contract or identification number | C19474 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $1,335 | | Are there contracts with allocated funds for individual policies? | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,335 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 527524 |
| Policy instance | 1 |
| Insurance contract or identification number | 527524 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,515 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,515 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05563219 |
| Policy instance | 4 |
| Insurance contract or identification number | KM05563219 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,614 | | 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 $13,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,614 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 713224 |
| Policy instance | 3 |
| Insurance contract or identification number | 713224 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,513 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HSA | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,513 | | Insurance broker organization code? | 3 | | Insurance broker name | DM LOVITT INSURANCE |
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