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THE AUTO CLUB GROUP MEDICAL CARE PLAN 401k Plan overview

Plan NameTHE AUTO CLUB GROUP MEDICAL CARE PLAN
Plan identification number 502

THE AUTO CLUB GROUP MEDICAL CARE PLAN Benefits

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

401k Sponsoring company profile

AUTO CLUB INSURANCE ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:AUTO CLUB INSURANCE ASSOCIATION
Employer identification number (EIN):380477270
NAIC Classification:524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE AUTO CLUB GROUP MEDICAL CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-01-01CARMEN MABE2024-09-10
5022022-01-01CARMEN MABE2023-10-02
5022021-01-01CARMEN MABE2022-10-27
5022020-01-01CARMEN MABE2021-10-06
5022019-01-01JOHN BRUNO2020-09-18
5022018-01-01JOHN BRUNO2019-10-04
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01
5022012-01-01ANN F. FEDERICI
5022011-01-01ANN F. FEDERICI
5022009-01-01ANN F. FEDERICI
5022008-01-01JOHN GRYNIEWICZ

Plan Statistics for THE AUTO CLUB GROUP MEDICAL CARE PLAN

401k plan membership statisitcs for THE AUTO CLUB GROUP MEDICAL CARE PLAN

Measure Date Value
2023: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-017,329
Total number of active participants reported on line 7a of the Form 55002023-01-017,077
Number of retired or separated participants receiving benefits2023-01-0161
Total of all active and inactive participants2023-01-017,138
Total participants2023-01-017,138
2022: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-017,670
Total number of active participants reported on line 7a of the Form 55002022-01-017,287
Number of retired or separated participants receiving benefits2022-01-0142
Total of all active and inactive participants2022-01-017,329
Total participants2022-01-017,329
2021: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-017,792
Total number of active participants reported on line 7a of the Form 55002021-01-017,385
Number of retired or separated participants receiving benefits2021-01-01285
Total of all active and inactive participants2021-01-017,670
Total participants2021-01-017,670
2020: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-017,986
Total number of active participants reported on line 7a of the Form 55002020-01-017,615
Number of retired or separated participants receiving benefits2020-01-01177
Total of all active and inactive participants2020-01-017,792
Total participants2020-01-017,792
2019: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-016,230
Total number of active participants reported on line 7a of the Form 55002019-01-017,866
Number of retired or separated participants receiving benefits2019-01-01120
Total of all active and inactive participants2019-01-017,986
Total participants2019-01-017,986
2018: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-016,333
Total number of active participants reported on line 7a of the Form 55002018-01-016,141
Number of retired or separated participants receiving benefits2018-01-0189
Total of all active and inactive participants2018-01-016,230
Total participants2018-01-016,230
2017: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-016,270
Total number of active participants reported on line 7a of the Form 55002017-01-016,230
Number of retired or separated participants receiving benefits2017-01-01103
Total of all active and inactive participants2017-01-016,333
Total participants2017-01-016,333
2016: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-015,956
Total number of active participants reported on line 7a of the Form 55002016-01-016,225
Number of retired or separated participants receiving benefits2016-01-0145
Total of all active and inactive participants2016-01-016,270
Total participants2016-01-016,270
2015: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-015,792
Total number of active participants reported on line 7a of the Form 55002015-01-015,914
Number of retired or separated participants receiving benefits2015-01-0142
Total of all active and inactive participants2015-01-015,956
Total participants2015-01-015,956
2014: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-016,222
Total number of active participants reported on line 7a of the Form 55002014-01-015,630
Number of retired or separated participants receiving benefits2014-01-01162
Total of all active and inactive participants2014-01-015,792
Total participants2014-01-015,792
2013: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-015,268
Total number of active participants reported on line 7a of the Form 55002013-01-016,072
Number of retired or separated participants receiving benefits2013-01-01150
Total of all active and inactive participants2013-01-016,222
Total participants2013-01-016,222
2012: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-015,204
Total number of active participants reported on line 7a of the Form 55002012-01-013,812
Number of retired or separated participants receiving benefits2012-01-011,456
Total of all active and inactive participants2012-01-015,268
Total participants2012-01-015,268
2011: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-015,362
Total number of active participants reported on line 7a of the Form 55002011-01-013,691
Number of retired or separated participants receiving benefits2011-01-011,513
Total of all active and inactive participants2011-01-015,204
Total participants2011-01-015,204
2009: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-015,777
Total number of active participants reported on line 7a of the Form 55002009-01-013,712
Number of retired or separated participants receiving benefits2009-01-011,808
Total of all active and inactive participants2009-01-015,520
Total participants2009-01-015,520
2008: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-015,938
Total number of active participants reported on line 7a of the Form 55002008-01-014,092
Number of retired or separated participants receiving benefits2008-01-011,685
Total of all active and inactive participants2008-01-015,777
Total participants2008-01-015,777

Financial Data on THE AUTO CLUB GROUP MEDICAL CARE PLAN

Measure Date Value
2012 : THE AUTO CLUB GROUP MEDICAL CARE PLAN 2012 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$14,955
Total income from all sources (including contributions)2012-12-31$33,048,709
Total of all expenses incurred2012-12-31$35,402,983
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$34,042,103
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$33,048,351
Value of total assets at beginning of year2012-12-31$2,369,229
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$1,360,880
Total interest from all sources2012-12-31$358
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$10,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$10,185,506
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$120,229
Liabilities. Value of operating payables at beginning of year2012-12-31$14,955
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-2,354,274
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,354,274
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$2,249,000
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$2,249,000
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$358
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$7,412,083
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$22,862,845
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$26,630,020
Contract administrator fees2012-12-31$1,360,880
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31GEORGE JOHNSON & COMPANY
Accountancy firm EIN2012-12-31382029668
2011 : THE AUTO CLUB GROUP MEDICAL CARE PLAN 2011 401k financial data
Total transfer of assets to this plan2011-12-31$1,595
Total transfer of assets from this plan2011-12-31$468,000
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$14,955
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$399,834
Total income from all sources (including contributions)2011-12-31$35,650,538
Total of all expenses incurred2011-12-31$34,994,123
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$33,043,025
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$35,650,119
Value of total assets at end of year2011-12-31$2,369,229
Value of total assets at beginning of year2011-12-31$2,564,098
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,951,098
Total interest from all sources2011-12-31$419
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$9,940,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$120,229
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$98
Liabilities. Value of operating payables at end of year2011-12-31$14,955
Liabilities. Value of operating payables at beginning of year2011-12-31$399,834
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$656,415
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,354,274
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,164,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$2,249,000
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$2,564,000
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$2,564,000
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$419
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$7,174,169
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$25,710,119
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$25,868,856
Contract administrator fees2011-12-31$1,951,098
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31GEORGE JOHNSON & COMPANY
Accountancy firm EIN2011-12-31382029668
2010 : THE AUTO CLUB GROUP MEDICAL CARE PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$399,834
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$16,203
Total income from all sources (including contributions)2010-12-31$41,943,644
Total of all expenses incurred2010-12-31$43,182,304
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$40,714,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$41,942,985
Value of total assets at end of year2010-12-31$2,564,098
Value of total assets at beginning of year2010-12-31$3,419,127
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$2,467,388
Total interest from all sources2010-12-31$659
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$11,538,251
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$98
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$144,127
Liabilities. Value of operating payables at end of year2010-12-31$399,834
Liabilities. Value of operating payables at beginning of year2010-12-31$16,203
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-1,238,660
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,164,264
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$3,402,924
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$2,564,000
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$3,275,000
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$3,275,000
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$659
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$10,175,924
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$30,404,734
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$30,538,992
Contract administrator fees2010-12-31$2,467,388
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31GEORGE JOHNSON & COMPANY
Accountancy firm EIN2010-12-31382029668

Form 5500 Responses for THE AUTO CLUB GROUP MEDICAL CARE PLAN

2023: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entityMulitple employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple employer plan
2021-01-01Submission has been amendedYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulitple 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: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: THE AUTO CLUB GROUP MEDICAL CARE PLAN 2008 form 5500 responses
2008-01-01Type of plan entityMulitple employer plan
2008-01-01Submission has been amendedYes
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered7
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $2,170
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,251
Health Insurance Welfare BenefitYes
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 $2,251
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,040
Health Insurance Welfare BenefitYes
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 $2,040
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,069
Health Insurance Welfare BenefitYes
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 $2,069
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,954
Health Insurance Welfare BenefitYes
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 $1,954
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract numberB3830
Policy instance 1
Insurance contract or identification numberB3830
Number of Individuals Covered110
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 2
Insurance contract or identification numberSP0001040
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,293
Health Insurance Welfare BenefitYes
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 $2,293
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 3
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,124
Health Insurance Welfare BenefitYes
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 $2,124
Insurance broker nameAON RISK SERVICES OF PR
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number10002659
Policy instance 2
Insurance contract or identification number10002659
Number of Individuals Covered799
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,555,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract numberB3830
Policy instance 1
Insurance contract or identification numberB3830
Number of Individuals Covered90
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number10002659
Policy instance 2
Insurance contract or identification number10002659
Number of Individuals Covered982
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract numberB3830
Policy instance 1
Insurance contract or identification numberB3830
Number of Individuals Covered108
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 3
Insurance contract or identification numberSP0001040
Number of Individuals Covered7
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,157
Health Insurance Welfare BenefitYes
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 $2,157
Insurance broker nameAON RISK SERVICES OF PR
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract numberB3830
Policy instance 1
Insurance contract or identification numberB3830
Number of Individuals Covered100
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 3
Insurance contract or identification numberSP0001040
Number of Individuals Covered6
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,016
Health Insurance Welfare BenefitYes
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 $2,016
Insurance broker nameAON RISK SERVICES OF PR
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number10002659
Policy instance 2
Insurance contract or identification number10002659
Number of Individuals Covered1096
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number10002659
Policy instance 2
Insurance contract or identification number10002659
Number of Individuals Covered1315
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract numberB3830
Policy instance 3
Insurance contract or identification numberB3830
Number of Individuals Covered80
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract numberSP0001040
Policy instance 1
Insurance contract or identification numberSP0001040
Number of Individuals Covered8
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,418
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Life 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 $2,418
Insurance broker nameAON RISK SERVICES OF PR
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number100860A AC R RA
Policy instance 2
Insurance contract or identification number100860A AC R RA
Number of Individuals Covered1226
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,761,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00100004/0001
Policy instance 1
Insurance contract or identification number00100004/0001
Number of Individuals Covered624
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,531,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number100860A AC R RA
Policy instance 2
Insurance contract or identification number100860A AC R RA
Number of Individuals Covered1309
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,635,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00100004/0001
Policy instance 1
Insurance contract or identification number00100004/0001
Number of Individuals Covered715
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,658,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00100004/0001
Policy instance 1
Insurance contract or identification number00100004/0001
Number of Individuals Covered1114
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,694,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number100860A AC R RA
Policy instance 2
Insurance contract or identification number100860A AC R RA
Number of Individuals Covered1899
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,491,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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