CAP AMERICA, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CAP AMERICA GROUP INSURANCE PLAN
Measure | Date | Value |
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2022: CAP AMERICA GROUP INSURANCE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 237 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 237 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 69 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 306 |
2021: CAP AMERICA GROUP INSURANCE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 190 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 237 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 20 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 257 |
2020: CAP AMERICA GROUP INSURANCE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 198 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 190 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 43 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 233 |
2019: CAP AMERICA GROUP INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 193 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 198 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 31 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 229 |
2018: CAP AMERICA GROUP INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 193 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 33 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 226 |
2017: CAP AMERICA GROUP INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 180 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 184 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 36 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 220 |
2016: CAP AMERICA GROUP INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 165 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 180 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 35 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 215 |
2015: CAP AMERICA GROUP INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 109 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 165 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 26 |
Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
Total of all active and inactive participants | 2015-01-01 | 191 |
2014: CAP AMERICA GROUP INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 146 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 109 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 15 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 124 |
2013: CAP AMERICA GROUP INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 90 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 146 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 10 |
Total of all active and inactive participants | 2013-01-01 | 156 |
2012: CAP AMERICA GROUP INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 109 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 90 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 9 |
Total of all active and inactive participants | 2012-01-01 | 99 |
2011: CAP AMERICA GROUP INSURANCE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 106 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 103 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 6 |
Total of all active and inactive participants | 2011-01-01 | 109 |
Total participants | 2011-01-01 | 109 |
2010: CAP AMERICA GROUP INSURANCE PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 104 |
Number of retired or separated participants receiving benefits | 2010-01-01 | 2 |
Total of all active and inactive participants | 2010-01-01 | 106 |
Total participants | 2010-01-01 | 106 |
2009: CAP AMERICA GROUP INSURANCE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 124 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 2 |
Total of all active and inactive participants | 2009-01-01 | 126 |
Total participants | 2009-01-01 | 126 |
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 308810 |
Policy instance | 5 |
Insurance contract or identification number | 308810 | Number of Individuals Covered | 412 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,127 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,531 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,127 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 923574 |
Policy instance | 4 |
Insurance contract or identification number | 923574 | Number of Individuals Covered | 300 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of fees paid to insurance company | USD $45,940 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,125,121 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 45940 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 3 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 350 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,052 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,052 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 2 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 397 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $15,708 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $108,037 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,708 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 1 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 104 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $12,326 | Total amount of fees paid to insurance company | USD $1,240 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,151 | Amount paid for insurance broker fees | 720 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 1 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 78 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $6,174 | Total amount of fees paid to insurance company | USD $1,555 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,424 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,332 | Amount paid for insurance broker fees | 1093 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 2 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 339 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $8,300 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,065 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,300 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 3 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 288 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,645 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,645 | Insurance broker organization code? | 3 |
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HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 ) |
Policy contract number | |
Policy instance | 4 |
Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,749 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $-1,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,749 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 923574 |
Policy instance | 5 |
Insurance contract or identification number | 923574 | Number of Individuals Covered | 239 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,416 | Total amount of fees paid to insurance company | USD $28,940 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,194,561 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,416 | Amount paid for insurance broker fees | 28940 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 308810 |
Policy instance | 6 |
Insurance contract or identification number | 308810 | Number of Individuals Covered | 564 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,069 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,632 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,069 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 1 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 78 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $10,812 | Total amount of fees paid to insurance company | USD $894 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $60,731 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,320 | Amount paid for insurance broker fees | 528 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 2 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 267 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,954 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $68,904 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,871 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 3 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 220 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,519 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,446 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,499 | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 207 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $40,206 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,946 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,206 | Insurance broker organization code? | 3 |
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HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 114 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $63 | Total amount of fees paid to insurance company | USD $2,130 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,449,722 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63 | Amount paid for insurance broker fees | 2130 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907195 |
Policy instance | 1 |
Insurance contract or identification number | 907195 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of fees paid to insurance company | USD $2,498 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2498 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 2 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 107 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $11,038 | Total amount of fees paid to insurance company | USD $996 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,208 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,442 | Amount paid for insurance broker fees | 510 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 3 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 307 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $7,235 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,741 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,884 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 4 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 265 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,773 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,145 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,340 | Insurance broker organization code? | 3 |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 290 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $26,265 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,062 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,265 | Insurance broker organization code? | 3 |
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HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 ) |
Policy contract number | |
Policy instance | 6 |
Number of Individuals Covered | 142 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $9,323 | Total amount of fees paid to insurance company | USD $-927 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,187,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,323 | Amount paid for insurance broker fees | -927 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907195 |
Policy instance | 1 |
Insurance contract or identification number | 907195 | Number of Individuals Covered | 204 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of fees paid to insurance company | USD $29,607 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $892,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 29607 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010206418 |
Policy instance | 2 |
Insurance contract or identification number | 000010206418 | Number of Individuals Covered | 271 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $486 | Total amount of fees paid to insurance company | USD $193 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $486 | Amount paid for insurance broker fees | 193 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 88 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,142 | Total amount of fees paid to insurance company | USD $285 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,479 | Amount paid for insurance broker fees | 145 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400001000 |
Policy instance | 4 |
Insurance contract or identification number | 000400001000 | Number of Individuals Covered | 81 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $2,441 | Total amount of fees paid to insurance company | USD $911 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,276 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,441 | Amount paid for insurance broker fees | 911 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 5 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 295 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,714 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $63,305 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,714 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 6 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 235 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,488 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,879 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,488 | Insurance broker organization code? | 3 |
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ADVANTICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12278 ) |
Policy contract number | 17081001 |
Policy instance | 8 |
Insurance contract or identification number | 17081001 | Number of Individuals Covered | 220 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $610 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,097 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $610 | Insurance broker organization code? | 3 | Insurance broker name | USI MIDWEST LLC |
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DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
Policy contract number | 08170500 |
Policy instance | 7 |
Insurance contract or identification number | 08170500 | Number of Individuals Covered | 280 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,614 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,038 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,614 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400206419 |
Policy instance | 6 |
Insurance contract or identification number | 000400206419 | Number of Individuals Covered | 116 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-07-31 | Total amount of commissions paid to insurance broker | USD $722 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,633 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $722 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400001000 |
Policy instance | 5 |
Insurance contract or identification number | 000400001000 | Number of Individuals Covered | 75 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,719 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,127 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,719 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00001D030690 |
Policy instance | 4 |
Insurance contract or identification number | 00001D030690 | Number of Individuals Covered | 139 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-07-31 | Total amount of commissions paid to insurance broker | USD $757 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,135 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $757 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 82 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $9,289 | Total amount of fees paid to insurance company | USD $1,470 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,459 | Amount paid for insurance broker fees | 806 | Insurance broker organization code? | 3 | Insurance broker name | DEBRA ANN OWEN |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010206418 |
Policy instance | 2 |
Insurance contract or identification number | 000010206418 | Number of Individuals Covered | 215 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-07-31 | Total amount of commissions paid to insurance broker | USD $299 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,300 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $299 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907195 |
Policy instance | 1 |
Insurance contract or identification number | 907195 | Number of Individuals Covered | 196 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of fees paid to insurance company | USD $29,395 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $821,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 31062 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOC LLC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400001000 |
Policy instance | 5 |
Insurance contract or identification number | 000400001000 | Number of Individuals Covered | 81 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,088 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,252 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,088 | Insurance broker organization code? | 3 | Insurance broker name | USI MIDWEST INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00001D030690 |
Policy instance | 4 |
Insurance contract or identification number | 00001D030690 | Number of Individuals Covered | 138 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,977 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,425 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,977 | Insurance broker organization code? | 3 | Insurance broker name | USI MIDWEST INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 111 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $6,407 | Total amount of fees paid to insurance company | USD $165 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,415 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,163 | Amount paid for insurance broker fees | 69 | Insurance broker organization code? | 3 | Insurance broker name | JOSEPH NISWONGER |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010206418 |
Policy instance | 2 |
Insurance contract or identification number | 000010206418 | Number of Individuals Covered | 219 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $199 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $199 | Insurance broker organization code? | 3 | Insurance broker name | USI MIDWEST INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 1 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 188 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $25,164 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $792,502 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,357 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOCIATES |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000400206419 |
Policy instance | 6 |
Insurance contract or identification number | 000400206419 | Number of Individuals Covered | 114 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $495 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $495 | Insurance broker organization code? | 3 | Insurance broker name | USI MIDWEST INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 74 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $4,526 | Total amount of fees paid to insurance company | USD $440 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,448 | Amount paid for insurance broker fees | 314 | Insurance broker organization code? | 3 | Insurance broker name | DEBRA ANN OWEN |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 1 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 169 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $21,193 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $754,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,815 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOCIATES |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00469627 |
Policy instance | 2 |
Insurance contract or identification number | 00469627 | Number of Individuals Covered | 203 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $6,723 | Total amount of fees paid to insurance company | USD $713 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $81,013 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,723 | Amount paid for insurance broker fees | 713 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY AND ASSOC INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 1 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 151 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $20,558 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $551,337 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,051 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOCIATES |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00469627 |
Policy instance | 2 |
Insurance contract or identification number | 00469627 | Number of Individuals Covered | 181 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $6,516 | Total amount of fees paid to insurance company | USD $3,747 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,031 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,516 | Amount paid for insurance broker fees | 3747 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY AND ASSOC INC |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 77 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $11,331 | Total amount of fees paid to insurance company | USD $1,306 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $47,948 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,583 | Amount paid for insurance broker fees | 714 | Insurance broker organization code? | 3 | Insurance broker name | RICHARD C LANDMANN |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00469627 |
Policy instance | 2 |
Insurance contract or identification number | 00469627 | Number of Individuals Covered | 166 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $4,132 | Total amount of fees paid to insurance company | USD $1,148 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,808 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,078 | Amount paid for insurance broker fees | 1148 | Insurance broker organization code? | 3 | Insurance broker name | DAVID G BOYKIN |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3905171 |
Policy instance | 3 |
Insurance contract or identification number | E3905171 | Number of Individuals Covered | 86 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $19,983 | Total amount of fees paid to insurance company | USD $3,621 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,834 | Amount paid for insurance broker fees | 1894 | Insurance broker organization code? | 3 | Insurance broker name | RICHARD C LANDMANN |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 1 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 139 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $22,941 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $535,009 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,853 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOCIATES |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 4 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 128 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $19,363 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $490,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | # AUL89 |
Policy instance | 3 |
Insurance contract or identification number | # AUL89 | Number of Individuals Covered | 51 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,504 | Total amount of fees paid to insurance company | USD $105 | Other welfare benefits provided | AFLAC | Welfare Benefit Premiums Paid to Carrier | USD $33,503 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 152045 |
Policy instance | 2 |
Insurance contract or identification number | 152045 | Number of Individuals Covered | 157 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $1,237 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00469627 |
Policy instance | 1 |
Insurance contract or identification number | 00469627 | Number of Individuals Covered | 101 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,021 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,400 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 383139 |
Policy instance | 4 |
Insurance contract or identification number | 383139 | Number of Individuals Covered | 125 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $19,177 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $426,343 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,177 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES-MURPHY & ASSOCIATES |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | # AUL89 |
Policy instance | 3 |
Insurance contract or identification number | # AUL89 | Number of Individuals Covered | 51 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $5,047 | Total amount of fees paid to insurance company | USD $131 | Other welfare benefits provided | AFLAC | Welfare Benefit Premiums Paid to Carrier | USD $38,226 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2 | Amount paid for insurance broker fees | 30 | Insurance broker organization code? | 3 | Insurance broker name | JEREMY CONGO |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 152045 |
Policy instance | 1 |
Insurance contract or identification number | 152045 | Number of Individuals Covered | 145 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $2,118 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,118 | Insurance broker organization code? | 3 | Insurance broker name | HOLMES MURPHY AND ASSOC INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0714957 |
Policy instance | 2 |
Insurance contract or identification number | 0714957 | Number of Individuals Covered | 201 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-07-31 | Total amount of commissions paid to insurance broker | USD $3,286 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,286 | Insurance broker organization code? | 3 | Insurance broker name | ADRIAN N BAKER & COMPANY |
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