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HELICOPTERS, INC. HEALTH INSURANCE PLAN 401k Plan overview

Plan NameHELICOPTERS, INC. HEALTH INSURANCE PLAN
Plan identification number 502

HELICOPTERS, INC. HEALTH INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

HELICOPTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name:HELICOPTERS, INC.
Employer identification number (EIN):431252563
NAIC Classification:481000
NAIC Description: Air Transportation

Additional information about HELICOPTERS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2003-03-21
Company Identification Number: P03000032742
Legal Registered Office Address: 520 CROWNE LOOP

ORMOND BEACH

32174

More information about HELICOPTERS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HELICOPTERS, INC. HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-06-01JACK DONNELLY2022-11-29
5022020-06-01
5022019-06-01
5022018-06-01
5022017-06-01JEFFREY LIEBER JEFFREY LIEBER2018-10-18
5022016-06-01JEFFREY LIEBER JEFFREY LIEBER2017-10-14
5022015-06-01JEFFREY LIEBER JEFFREY LIEBER2016-11-10
5022014-06-01JEFFREY LIEBER JEFFREY LIEBER2015-11-18
5022013-06-01JEFFREY LIEBER JEFFREY LIEBER2014-12-18
5022012-06-01JEFFREY LIEBER JEFFREY LIEBER2014-12-18
5022011-06-01JEFFREY LIEBER JEFFREY LIEBER2015-01-15
5022010-06-01JEFFREY LIEBER JEFFREY LIEBER2014-12-18
5022009-06-01JEFFREY LIEBER JEFFREY LIEBER2014-12-18
5022008-06-01JEFFREY LIEBER JEFFREY LIEBER2014-12-18

Plan Statistics for HELICOPTERS, INC. HEALTH INSURANCE PLAN

401k plan membership statisitcs for HELICOPTERS, INC. HEALTH INSURANCE PLAN

Measure Date Value
2021: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01109
Total number of active participants reported on line 7a of the Form 55002021-06-01104
Number of retired or separated participants receiving benefits2021-06-013
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01107
Number of employers contributing to the scheme2021-06-010
2020: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01119
Total number of active participants reported on line 7a of the Form 55002020-06-01110
Total of all active and inactive participants2020-06-01110
2019: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01114
Total number of active participants reported on line 7a of the Form 55002019-06-01119
Total of all active and inactive participants2019-06-01119
2018: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01116
Total number of active participants reported on line 7a of the Form 55002018-06-01114
Total of all active and inactive participants2018-06-01114
2017: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01116
Total number of active participants reported on line 7a of the Form 55002017-06-01116
Total of all active and inactive participants2017-06-01116
2016: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01110
Total number of active participants reported on line 7a of the Form 55002016-06-01116
Total of all active and inactive participants2016-06-01116
Total participants2016-06-01116
2015: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01289
Total number of active participants reported on line 7a of the Form 55002015-06-01110
Total of all active and inactive participants2015-06-01110
Total participants2015-06-01110
2014: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01226
Total number of active participants reported on line 7a of the Form 55002014-06-01289
Total of all active and inactive participants2014-06-01289
2013: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01196
Total number of active participants reported on line 7a of the Form 55002013-06-01226
Total of all active and inactive participants2013-06-01226
2012: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01175
Total number of active participants reported on line 7a of the Form 55002012-06-01196
Total of all active and inactive participants2012-06-01196
2011: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01156
Total number of active participants reported on line 7a of the Form 55002011-06-01175
Total of all active and inactive participants2011-06-01175
2010: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01153
Total number of active participants reported on line 7a of the Form 55002010-06-01156
Total of all active and inactive participants2010-06-01156
2009: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01164
Total number of active participants reported on line 7a of the Form 55002009-06-01153
Total of all active and inactive participants2009-06-01153
2008: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2008 401k membership
Total participants, beginning-of-year2008-06-0162
Total number of active participants reported on line 7a of the Form 55002008-06-01164
Total of all active and inactive participants2008-06-01164

Form 5500 Responses for HELICOPTERS, INC. HEALTH INSURANCE PLAN

2021: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – General assets of the sponsorYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – General assets of the sponsorYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – General assets of the sponsorYes
2009-06-01Plan benefit arrangement – InsuranceYes
2008: HELICOPTERS, INC. HEALTH INSURANCE PLAN 2008 form 5500 responses
2008-06-01Type of plan entitySingle employer plan
2008-06-01First time form 5500 has been submittedYes
2008-06-01Plan funding arrangement – InsuranceYes
2008-06-01Plan funding arrangement – General assets of the sponsorYes
2008-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number550548
Policy instance 1
Insurance contract or identification number550548
Number of Individuals Covered103
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $22,584
Total amount of fees paid to insurance companyUSD $5,950
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $118,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,636
Amount paid for insurance broker fees5950
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550548
Policy instance 1
Insurance contract or identification number00550548
Number of Individuals Covered105
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $26,008
Total amount of fees paid to insurance companyUSD $6,775
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,138
Amount paid for insurance broker fees6775
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550548
Policy instance 1
Insurance contract or identification number00550548
Number of Individuals Covered114
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $21,132
Total amount of fees paid to insurance companyUSD $5,091
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,962
Amount paid for insurance broker fees5091
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550548
Policy instance 1
Insurance contract or identification number00550548
Number of Individuals Covered104
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $16,925
Total amount of fees paid to insurance companyUSD $2,871
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $103,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,821
Amount paid for insurance broker fees2871
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER
Insurance broker organization code?3
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3463
Policy instance 1
Insurance contract or identification number3463
Number of Individuals Covered75
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $440
Total amount of fees paid to insurance companyUSD $4,080
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $440
Amount paid for insurance broker fees4080
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05917718
Policy instance 2
Insurance contract or identification numberKM05917718
Number of Individuals Covered101
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $4,082
Total amount of fees paid to insurance companyUSD $1,108
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,082
Amount paid for insurance broker fees51
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCP755-580663085
Policy instance 3
Insurance contract or identification numberCP755-580663085
Number of Individuals Covered18
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $2,333
Total amount of fees paid to insurance companyUSD $28
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,333
Amount paid for insurance broker fees28
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameVARIOUS-DETAILS ON FILE
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCP755-580663085
Policy instance 3
Insurance contract or identification numberCP755-580663085
Number of Individuals Covered16
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,463
Total amount of fees paid to insurance companyUSD $49
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,463
Amount paid for insurance broker fees49
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameVARIOUS-DETAILS ON FILE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05917718
Policy instance 2
Insurance contract or identification numberKM05917718
Number of Individuals Covered101
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $2,776
Total amount of fees paid to insurance companyUSD $976
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,776
Amount paid for insurance broker fees24
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3463
Policy instance 1
Insurance contract or identification number3463
Number of Individuals Covered63
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $364
Total amount of fees paid to insurance companyUSD $1,939
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $267
Amount paid for insurance broker fees1939
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER CONTINGENCIES
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberCP755-580663085
Policy instance 4
Insurance contract or identification numberCP755-580663085
Number of Individuals Covered16
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $2,622
Total amount of fees paid to insurance companyUSD $224
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,622
Amount paid for insurance broker fees224
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameVARIOUS-DETAILS ON FILE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05917718
Policy instance 3
Insurance contract or identification numberKM05917718
Number of Individuals Covered96
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $2,828
Total amount of fees paid to insurance companyUSD $2,534
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,177
Amount paid for insurance broker fees1172
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST INC
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3463
Policy instance 2
Insurance contract or identification number3463
Number of Individuals Covered49
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $267
Total amount of fees paid to insurance companyUSD $2,541
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $130
Amount paid for insurance broker fees2541
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER CONTINGENCIES
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number744559
Policy instance 1
Insurance contract or identification number744559
Number of Individuals Covered128
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $49
Total amount of fees paid to insurance companyUSD $19,089
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $935,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49
Amount paid for insurance broker fees14388
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameUSI MIDWEST LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number744559
Policy instance 1
Insurance contract or identification number744559
Number of Individuals Covered105
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $-129
Total amount of fees paid to insurance companyUSD $18,471
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $917,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-129
Amount paid for insurance broker fees18471
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number3463
Policy instance 2
Insurance contract or identification number3463
Number of Individuals Covered24
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $202
Total amount of fees paid to insurance companyUSD $687
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $202
Amount paid for insurance broker fees687
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICE FEES AND RISK OR OTHER CONTINGENCIES
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number744559
Policy instance 3
Insurance contract or identification number744559
Number of Individuals Covered97
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $5,722
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,722
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number744559
Policy instance 1
Insurance contract or identification number744559
Number of Individuals Covered103
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $18,735
Total amount of fees paid to insurance companyUSD $1,727
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $844,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,735
Insurance broker organization code?3
Amount paid for insurance broker fees1727
Additional information about fees paid to insurance brokerBONUS COMMISSION
Insurance broker nameHOLMES MURPHY & ASSOCIATES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number744559
Policy instance 2
Insurance contract or identification number744559
Number of Individuals Covered93
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $4,977
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,977
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number06072701-703
Policy instance 1
Insurance contract or identification number06072701-703
Number of Individuals Covered77
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $4,830
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )
Policy contract number00164672
Policy instance 2
Insurance contract or identification number00164672
Number of Individuals Covered98
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $4,294
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $871,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number06072701&702
Policy instance 1
Insurance contract or identification number06072701&702
Number of Individuals Covered65
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $4,105
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,105
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY
HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )
Policy contract number00164672
Policy instance 2
Insurance contract or identification number00164672
Number of Individuals Covered91
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $17,050
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $761,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,050
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )
Policy contract number00164672
Policy instance 2
Insurance contract or identification number00164672
Number of Individuals Covered91
Insurance policy start date2009-06-01
Insurance policy end date2010-05-31
Total amount of commissions paid to insurance brokerUSD $17,825
Total amount of fees paid to insurance companyUSD $2,444
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $734,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,825
Amount paid for insurance broker fees2444
Insurance broker organization code?3
Insurance broker nameM.KNIEPMAN-CORP BEN. STRATEGIES LLC
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number06072701&702
Policy instance 1
Insurance contract or identification number06072701&702
Number of Individuals Covered62
Insurance policy end date2010-05-31
Total amount of commissions paid to insurance brokerUSD $3,938
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,938
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY
HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )
Policy contract number00164672
Policy instance 2
Insurance contract or identification number00164672
Number of Individuals Covered96
Insurance policy start date2008-06-01
Insurance policy end date2009-05-31
Total amount of commissions paid to insurance brokerUSD $18,723
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $690,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,723
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY & ASSOCIATES INC
ADVANTICA ADMINISTRATIVE SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number06072701&702
Policy instance 1
Insurance contract or identification number06072701&702
Number of Individuals Covered68
Insurance policy end date2009-05-31
Total amount of commissions paid to insurance brokerUSD $3,930
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,930
Insurance broker organization code?3
Insurance broker nameHOLMES MURPHY

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