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LANTIS ENTERPRISES HEALTH INSURANCE 401k Plan overview

Plan NameLANTIS ENTERPRISES HEALTH INSURANCE
Plan identification number 501

LANTIS ENTERPRISES HEALTH INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name:LANTIS ENTERPRISES, INC.
Employer identification number (EIN):470615920
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LANTIS ENTERPRISES HEALTH INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01MICHAEL MOORE
5012016-01-01MICHAEL MOORE
5012015-01-01MICHAEL MOORE
5012014-01-01MICHAEL MOORE
5012013-01-01MICHAEL MOORE
5012012-01-01MICHAEL MOORE
5012011-01-01MICHAEL MOORE
5012009-01-01MICHAEL MOORE

Plan Statistics for LANTIS ENTERPRISES HEALTH INSURANCE

401k plan membership statisitcs for LANTIS ENTERPRISES HEALTH INSURANCE

Measure Date Value
2022: LANTIS ENTERPRISES HEALTH INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-01-01913
Total number of active participants reported on line 7a of the Form 55002022-01-01261
Total of all active and inactive participants2022-01-01261
Total participants2022-01-01261
2021: LANTIS ENTERPRISES HEALTH INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-01-011,123
Total number of active participants reported on line 7a of the Form 55002021-01-01913
Total of all active and inactive participants2021-01-01913
Total participants2021-01-01913
2020: LANTIS ENTERPRISES HEALTH INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-01-011,012
Total number of active participants reported on line 7a of the Form 55002020-01-011,123
Total of all active and inactive participants2020-01-011,123
Total participants2020-01-011,123
2019: LANTIS ENTERPRISES HEALTH INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-01-0152
Total number of active participants reported on line 7a of the Form 55002019-01-011,012
Total of all active and inactive participants2019-01-011,012
Total participants2019-01-011,012
Number of participants with account balances2019-01-010
2018: LANTIS ENTERPRISES HEALTH INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-01-0134
Total number of active participants reported on line 7a of the Form 55002018-01-0152
Total of all active and inactive participants2018-01-0152
Total participants2018-01-0152
2017: LANTIS ENTERPRISES HEALTH INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-01-0133
Total number of active participants reported on line 7a of the Form 55002017-01-0134
Total of all active and inactive participants2017-01-0134
Total participants2017-01-0134
2016: LANTIS ENTERPRISES HEALTH INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-0131
Total number of active participants reported on line 7a of the Form 55002016-01-0133
Total of all active and inactive participants2016-01-0133
Total participants2016-01-0133
2015: LANTIS ENTERPRISES HEALTH INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-0128
Total number of active participants reported on line 7a of the Form 55002015-01-0131
Total of all active and inactive participants2015-01-0131
Total participants2015-01-010
2014: LANTIS ENTERPRISES HEALTH INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-0122
Total number of active participants reported on line 7a of the Form 55002014-01-0128
Total of all active and inactive participants2014-01-0128
Total participants2014-01-010
2013: LANTIS ENTERPRISES HEALTH INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-0127
Total number of active participants reported on line 7a of the Form 55002013-01-0122
Total of all active and inactive participants2013-01-0122
Total participants2013-01-010
2012: LANTIS ENTERPRISES HEALTH INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-01457
Total number of active participants reported on line 7a of the Form 55002012-01-0127
Total of all active and inactive participants2012-01-0127
Total participants2012-01-010
2011: LANTIS ENTERPRISES HEALTH INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-01460
Total number of active participants reported on line 7a of the Form 55002011-01-01457
Total of all active and inactive participants2011-01-01457
Total participants2011-01-01457
2009: LANTIS ENTERPRISES HEALTH INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-01401
Total number of active participants reported on line 7a of the Form 55002009-01-01474
Total of all active and inactive participants2009-01-01474
Total participants2009-01-01474

Form 5500 Responses for LANTIS ENTERPRISES HEALTH INSURANCE

2022: LANTIS ENTERPRISES HEALTH INSURANCE 2022 form 5500 responses
2022-01-01Type of plan entitySingle 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: LANTIS ENTERPRISES HEALTH INSURANCE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: LANTIS ENTERPRISES HEALTH INSURANCE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: LANTIS ENTERPRISES HEALTH INSURANCE 2019 form 5500 responses
2019-01-01Type of plan entityMulitple employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: LANTIS ENTERPRISES HEALTH INSURANCE 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: LANTIS ENTERPRISES HEALTH INSURANCE 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: LANTIS ENTERPRISES HEALTH INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: LANTIS ENTERPRISES HEALTH INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: LANTIS ENTERPRISES HEALTH INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: LANTIS ENTERPRISES HEALTH INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: LANTIS ENTERPRISES HEALTH INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: LANTIS ENTERPRISES HEALTH INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: LANTIS ENTERPRISES HEALTH INSURANCE 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number228270
Policy instance 2
Insurance contract or identification number228270
Number of Individuals Covered238
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $53,668
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 $46,382
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberERR000315-01
Policy instance 1
Insurance contract or identification numberERR000315-01
Number of Individuals Covered23
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number228270
Policy instance 2
Insurance contract or identification number228270
Number of Individuals Covered887
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $91,450
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 $91,450
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberERR000315-01
Policy instance 1
Insurance contract or identification numberERR000315-01
Number of Individuals Covered26
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $72,382
Health 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 $63,248
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberERR000315-01
Policy instance 1
Insurance contract or identification numberERR000315-01
Number of Individuals Covered27
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $65,699
Health 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 $58,879
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number228270
Policy instance 2
Insurance contract or identification number228270
Number of Individuals Covered1022
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $91,530
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 $91,530
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number908222
Policy instance 3
Insurance contract or identification number908222
Number of Individuals Covered74
Insurance policy start date2020-01-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $561
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 $561
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number228270
Policy instance 3
Insurance contract or identification number228270
Number of Individuals Covered859
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $76,632
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 $76,632
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberERR000315-01
Policy instance 2
Insurance contract or identification numberERR000315-01
Number of Individuals Covered27
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $52,794
Total amount of fees paid to insurance companyUSD $6,542
Health 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 $52,794
Amount paid for insurance broker fees6267
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number908222
Policy instance 1
Insurance contract or identification number908222
Number of Individuals Covered126
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,802
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 $1,676
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberERR1117-17
Policy instance 2
Insurance contract or identification numberERR1117-17
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $37,024
Total amount of fees paid to insurance companyUSD $3,694
Health 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 $37,024
Amount paid for insurance broker fees3600
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number908222
Policy instance 1
Insurance contract or identification number908222
Insurance policy start date2018-04-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $458
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 $377
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberERR1117-17
Policy instance 2
Insurance contract or identification numberERR1117-17
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $27,679
Total amount of fees paid to insurance companyUSD $4,408
Health 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 $27,679
Amount paid for insurance broker fees2692
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
Insurance broker nameALLEGIANCE COBRA SERVICES, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466197
Policy instance 1
Insurance contract or identification number5466197
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,736
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 $1,736
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
Insurance broker nameLEAVITT GREAT WEST INS SERVICES LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberERR1117-15
Policy instance 2
Insurance contract or identification numberERR1117-15
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $24,786
Total amount of fees paid to insurance companyUSD $3,987
Health 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 $24,786
Amount paid for insurance broker fees2599
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
Insurance broker nameALLEGIANCE COBRA SERVICES, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466197
Policy instance 1
Insurance contract or identification number5466197
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,168
Total amount of fees paid to insurance companyUSD $114
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 $1,168
Amount paid for insurance broker fees114
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
Insurance broker nameLEAVITT GREAT WEST INS SERVICES LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberERR1117-14
Policy instance 2
Insurance contract or identification numberERR1117-14
Number of Individuals Covered25
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $23,670
Total amount of fees paid to insurance companyUSD $3,343
Health 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 $23,670
Amount paid for insurance broker fees2410
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
Insurance broker nameALLEGIANCE COBRA SERVICES, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466197
Policy instance 1
Insurance contract or identification number5466197
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $862
Total amount of fees paid to insurance companyUSD $290
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 $862
Amount paid for insurance broker fees290
Additional information about fees paid to insurance brokerPRODUCER BONUS PROGRAM
Insurance broker organization code?3
Insurance broker nameLEAVITT GREAT WEST INS SERVICES LLC
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberAJS00680-12
Policy instance 1
Insurance contract or identification numberAJS00680-12
Number of Individuals Covered22
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $16,437
Total amount of fees paid to insurance companyUSD $5,931
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,437
Amount paid for insurance broker fees4327
Additional information about fees paid to insurance brokerADMINSTRATION FEES
Insurance broker organization code?3
Insurance broker namePAYNE FINANCIAL GROUP
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466197
Policy instance 2
Insurance contract or identification number5466197
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,009
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 $848
Insurance broker nameCOORDINATED CARE PARTNERS LLC
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberAJS00680-11
Policy instance 2
Insurance contract or identification numberAJS00680-11
Number of Individuals Covered27
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $71,385
Total amount of fees paid to insurance companyUSD $85,666
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2825
Additional information about fees paid to insurance brokerCASE MANAGEMENT FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $71,385
Insurance broker nameINTERMOUNTAIN UNDERWRITERS
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5349604
Policy instance 3
Insurance contract or identification number5349604
Number of Individuals Covered425
Insurance policy start date2012-01-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $4,303
Total amount of fees paid to insurance companyUSD $1,718
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
Amount paid for insurance broker fees1718
Additional information about fees paid to insurance brokerPRODUCER PROGRAM PAYMENT
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $4,303
Insurance broker namePAYNEWEST INSURANCE INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5466197
Policy instance 1
Insurance contract or identification number5466197
Number of Individuals Covered40
Insurance policy start date2012-12-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $80
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 $80
Insurance broker nameCOORDINATED CARE PARTNERS LLC
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberAJS00680-10
Policy instance 1
Insurance contract or identification numberAJS00680-10
Number of Individuals Covered352
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $78,453
Total amount of fees paid to insurance companyUSD $96,595
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5349604
Policy instance 2
Insurance contract or identification number5349604
Number of Individuals Covered457
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,206
Total amount of fees paid to insurance companyUSD $998
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
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract numberERR9960-5070-02
Policy instance 1
Insurance contract or identification numberERR9960-5070-02
Number of Individuals Covered375
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $71,995
Health 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 $71,995
Insurance broker nameINTERMOUNTAIN UNDERWRITERS
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5349604
Policy instance 2
Insurance contract or identification number5349604
Number of Individuals Covered460
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,019
Total amount of fees paid to insurance companyUSD $1,756
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
Additional information about fees paid to insurance brokerPRODUCER PROGRAM PAYMENT
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,019
Amount paid for insurance broker fees1756
Insurance broker namePAYNE FINANCIAL GROUP

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