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AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 401k Plan overview

Plan NameAUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN
Plan identification number 501

AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

AUCTION BROADCASTING COMPANY LLC has sponsored the creation of one or more 401k plans.

Company Name:AUCTION BROADCASTING COMPANY LLC
Employer identification number (EIN):352086532
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-10-01
5012017-10-01MICHAEL DAILY2019-01-16 MICHAEL DAILY2019-01-16
5012016-10-01MICHAEL DAILY MICHAEL DAILY2018-02-07
5012015-10-01MICHAEL DAILY MICHAEL DAILY2016-12-06
5012014-10-01MICHAEL DAILY MICHAEL DAILY2016-01-21
5012013-10-01MICHAEL DAILY MICHAEL DAILY2014-12-05
5012013-07-01MICHAEL DAILY MICHAEL DAILY2014-01-02
5012012-07-01MICHAEL DAILY
5012011-07-01MICHAEL DAILY
5012010-07-01MICHAEL DAILY
5012009-07-01 MICHAEL DAILY2010-12-21
5012009-07-01MICHAEL DAILY

Plan Statistics for AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN

401k plan membership statisitcs for AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN

Measure Date Value
2018: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-0128
Total number of active participants reported on line 7a of the Form 55002018-10-0123
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-10-010
Total participants2018-10-0123
2016: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01249
Total number of active participants reported on line 7a of the Form 55002016-10-0114
Number of retired or separated participants receiving benefits2016-10-011
Total of all active and inactive participants2016-10-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-10-010
Total participants2016-10-0115
2015: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01204
Total number of active participants reported on line 7a of the Form 55002015-10-01247
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-012
Total of all active and inactive participants2015-10-01249
Total participants2015-10-01249
2014: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01132
Total number of active participants reported on line 7a of the Form 55002014-10-01204
Total of all active and inactive participants2014-10-01204
Total participants2014-10-01204
2013: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01219
Total number of active participants reported on line 7a of the Form 55002013-10-01132
Total of all active and inactive participants2013-10-01132
Total participants2013-10-01132
Total participants, beginning-of-year2013-07-01219
Total number of active participants reported on line 7a of the Form 55002013-07-01235
Number of retired or separated participants receiving benefits2013-07-011
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-01236
2012: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01239
Total number of active participants reported on line 7a of the Form 55002012-07-01218
Number of retired or separated participants receiving benefits2012-07-011
Total of all active and inactive participants2012-07-01219
Total participants2012-07-01219
2011: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01266
Total number of active participants reported on line 7a of the Form 55002011-07-01234
Number of retired or separated participants receiving benefits2011-07-015
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01239
Total participants2011-07-01239
2010: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01250
Total number of active participants reported on line 7a of the Form 55002010-07-01266
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01266
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-01266
2009: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-0197
Total number of active participants reported on line 7a of the Form 55002009-07-01250
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-01250

Form 5500 Responses for AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN

2018: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planNo
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedYes
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – General assets of the sponsorYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: AUCTION BROADCASTING COMPANY LLC GROUP HEALTH PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0609740
Policy instance 2
Insurance contract or identification number0609740
Number of Individuals Covered23
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $2,950
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $26,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,590
Amount paid for insurance broker fees0
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00609740
Policy instance 1
Insurance contract or identification number00609740
Number of Individuals Covered22
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $8,400
Total amount of fees paid to insurance companyUSD $23,093
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $194,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,400
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES AND OTHER FEES INCLUDING DISEASE MGMT AND PRE-PAY AND POST-PAYMENT RECOVERY PROGRAMS
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0609740
Policy instance 2
Insurance contract or identification number0609740
Number of Individuals Covered239
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $19,222
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $194,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,222
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameH J SPIER CO INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00609740
Policy instance 1
Insurance contract or identification number00609740
Number of Individuals Covered213
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $79,590
Total amount of fees paid to insurance companyUSD $68,095
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $765,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,590
Insurance broker organization code?3
Amount paid for insurance broker fees68095
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES AND OTHER FEES INCLUDING DISEASE MGMT. AND PRE-PAY AND POST-PAYMENT RECOVERY PROGRAMS
Insurance broker nameCIGNA HEALTH AND LIFE INSURANCE COM
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00609740
Policy instance 2
Insurance contract or identification number00609740
Number of Individuals Covered199
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $60,870
Total amount of fees paid to insurance companyUSD $47,776
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $571,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees47776
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES AND OTHER FEES INCLUDING DISEASE MGMT. AND PRE-PAY AND POST-PAYMENT RECOVERY PROGRAMS
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $60,870
Insurance broker nameH J SPIER CO INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0609740
Policy instance 1
Insurance contract or identification number0609740
Number of Individuals Covered204
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $13,341
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $135,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,341
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameH J SPIER CO INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00609740
Policy instance 1
Insurance contract or identification number00609740
Number of Individuals Covered132
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $42,600
Total amount of fees paid to insurance companyUSD $33,742
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,600
Insurance broker organization code?3
Amount paid for insurance broker fees33742
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES AND OTHER FEES INCLUDING DISEASE MGMT. AND PRE-PAY AND POST-PAYMENT RECOVERY PROGRAMS
Insurance broker nameCIGNA HEALTH AND LIFE INSURANCE COM
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00196964
Policy instance 1
Insurance contract or identification number00196964
Number of Individuals Covered236
Insurance policy start date2013-07-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $278,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00196964
Policy instance 1
Insurance contract or identification number00196964
Number of Individuals Covered219
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $26,362
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,196,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,362
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT
Insurance broker organization code?3
Insurance broker nameH J SPIER CO INC
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00196964
Policy instance 1
Insurance contract or identification number00196964
Number of Individuals Covered239
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $27,265
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,314,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00196964
Policy instance 1
Insurance contract or identification number00196964
Number of Individuals Covered266
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $30,502
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,277,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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