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ST. LUKES HOSPITAL FLEXCARE PLAN 401k Plan overview

Plan NameST. LUKES HOSPITAL FLEXCARE PLAN
Plan identification number 505

ST. LUKES HOSPITAL FLEXCARE PLAN Benefits

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

401k Sponsoring company profile

ST. LUKES HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:ST. LUKES HOSPITAL
Employer identification number (EIN):344428232
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about ST. LUKES HOSPITAL

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1950-12-12
Company Identification Number: 220964
Legal Registered Office Address: 5901 MONCLOVA RD
-
MAUMEE
United States of America (USA)
43537

More information about ST. LUKES HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. LUKES HOSPITAL FLEXCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052020-01-01STEVEN THOMPSON2021-10-01
5052019-01-01KEVIN RILEY2020-09-17
5052018-01-01DANIEL WAKEMAN2019-09-26
5052017-01-01
5052016-01-01
5052015-01-01DAN WAKEMAN
5052014-01-01KAREN STRAUSS
5052013-01-01KATHLEEN HANLEY
5052012-01-01KATHLEEN HANLEY
5052011-01-01KATHLEEN HANLEY
5052010-01-01KATHLEEN HANLEY KATHLEEN HANLEY2011-10-17
5052009-01-01DEBRA BALL

Plan Statistics for ST. LUKES HOSPITAL FLEXCARE PLAN

401k plan membership statisitcs for ST. LUKES HOSPITAL FLEXCARE PLAN

Measure Date Value
2020: ST. LUKES HOSPITAL FLEXCARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,354
Total number of active participants reported on line 7a of the Form 55002020-01-011,814
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-011,814
Number of employers contributing to the scheme2020-01-010
2019: ST. LUKES HOSPITAL FLEXCARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,367
Total number of active participants reported on line 7a of the Form 55002019-01-011,354
Number of retired or separated participants receiving benefits2019-01-0118
Number of other retired or separated participants entitled to future benefits2019-01-0125
Total of all active and inactive participants2019-01-011,397
Number of employers contributing to the scheme2019-01-010
2018: ST. LUKES HOSPITAL FLEXCARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,328
Total number of active participants reported on line 7a of the Form 55002018-01-011,359
Number of retired or separated participants receiving benefits2018-01-016
Number of other retired or separated participants entitled to future benefits2018-01-0110
Total of all active and inactive participants2018-01-011,375
Number of employers contributing to the scheme2018-01-010
2017: ST. LUKES HOSPITAL FLEXCARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,096
Total number of active participants reported on line 7a of the Form 55002017-01-011,334
Number of retired or separated participants receiving benefits2017-01-0119
Total of all active and inactive participants2017-01-011,353
Total participants2017-01-011,353
2016: ST. LUKES HOSPITAL FLEXCARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,075
Total number of active participants reported on line 7a of the Form 55002016-01-011,096
Total of all active and inactive participants2016-01-011,096
Total participants2016-01-011,096
2015: ST. LUKES HOSPITAL FLEXCARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,147
Total number of active participants reported on line 7a of the Form 55002015-01-011,075
Number of retired or separated participants receiving benefits2015-01-019
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,084
2014: ST. LUKES HOSPITAL FLEXCARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,209
Total number of active participants reported on line 7a of the Form 55002014-01-011,139
Number of retired or separated participants receiving benefits2014-01-018
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,147
2013: ST. LUKES HOSPITAL FLEXCARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,243
Total number of active participants reported on line 7a of the Form 55002013-01-011,203
Number of retired or separated participants receiving benefits2013-01-016
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,209
2012: ST. LUKES HOSPITAL FLEXCARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,350
Total number of active participants reported on line 7a of the Form 55002012-01-011,235
Number of retired or separated participants receiving benefits2012-01-018
Total of all active and inactive participants2012-01-011,243
2011: ST. LUKES HOSPITAL FLEXCARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,472
Total number of active participants reported on line 7a of the Form 55002011-01-011,341
Number of retired or separated participants receiving benefits2011-01-019
Total of all active and inactive participants2011-01-011,350
2010: ST. LUKES HOSPITAL FLEXCARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-012,276
Total number of active participants reported on line 7a of the Form 55002010-01-011,447
Number of retired or separated participants receiving benefits2010-01-0125
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,472
2009: ST. LUKES HOSPITAL FLEXCARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,132
Total number of active participants reported on line 7a of the Form 55002009-01-011,457
Number of retired or separated participants receiving benefits2009-01-01346
Number of other retired or separated participants entitled to future benefits2009-01-01473
Total of all active and inactive participants2009-01-012,276

Form 5500 Responses for ST. LUKES HOSPITAL FLEXCARE PLAN

2020: ST. LUKES HOSPITAL FLEXCARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: ST. LUKES HOSPITAL FLEXCARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: ST. LUKES HOSPITAL FLEXCARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: ST. LUKES HOSPITAL FLEXCARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: ST. LUKES HOSPITAL FLEXCARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: ST. LUKES HOSPITAL FLEXCARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: ST. LUKES HOSPITAL FLEXCARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: ST. LUKES HOSPITAL FLEXCARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: ST. LUKES HOSPITAL FLEXCARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: ST. LUKES HOSPITAL FLEXCARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: ST. LUKES HOSPITAL FLEXCARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: ST. LUKES HOSPITAL FLEXCARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number34544
Policy instance 4
Insurance contract or identification number34544
Number of Individuals Covered1264
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,104
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $177,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,104
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number35578
Policy instance 3
Insurance contract or identification number35578
Number of Individuals Covered766
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148067
Policy instance 2
Insurance contract or identification number148067
Number of Individuals Covered1045
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,900
Total amount of fees paid to insurance companyUSD $3,399
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $379,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,900
Amount paid for insurance broker fees3399
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered2314
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,561
Total amount of fees paid to insurance companyUSD $3,711
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,561
Amount paid for insurance broker fees3711
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?3
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number34544
Policy instance 4
Insurance contract or identification number34544
Number of Individuals Covered1369
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,346
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $178,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,346
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number35578
Policy instance 3
Insurance contract or identification number35578
Number of Individuals Covered822
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148067
Policy instance 2
Insurance contract or identification number148067
Number of Individuals Covered1075
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $10,750
Total amount of fees paid to insurance companyUSD $3,259
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $508,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,750
Amount paid for insurance broker fees3259
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered2466
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,197
Total amount of fees paid to insurance companyUSD $2,706
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,197
Amount paid for insurance broker fees2706
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148067
Policy instance 3
Insurance contract or identification number148067
Number of Individuals Covered729
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $10,255
Total amount of fees paid to insurance companyUSD $2,798
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $373,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,255
Amount paid for insurance broker fees2798
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number35578
Policy instance 4
Insurance contract or identification number35578
Number of Individuals Covered784
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number34544
Policy instance 2
Insurance contract or identification number34544
Number of Individuals Covered1337
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $48,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered2363
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $18,056
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,056
Amount paid for insurance broker fees0
Insurance broker organization code?3
PARAMOUNT HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95189 )
Policy contract number031514
Policy instance 5
Insurance contract or identification number031514
Number of Individuals Covered2177
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $115,003
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $493,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $115,003
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number34544
Policy instance 4
Insurance contract or identification number34544
Number of Individuals Covered1204
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,505
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,505
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number35578
Policy instance 3
Insurance contract or identification number35578
Number of Individuals Covered1585
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number148067
Policy instance 2
Insurance contract or identification number148067
Number of Individuals Covered804
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $10,469
Total amount of fees paid to insurance companyUSD $3,020
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $402,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,469
Amount paid for insurance broker fees3020
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number0000909
Policy instance 1
Insurance contract or identification number0000909
Number of Individuals Covered2367
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $12,776
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,776
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC

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