OLTMANS COMPANIES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OLTMANS COMPANIES HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2021: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-08-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 148 |
Number of retired or separated participants receiving benefits | 2021-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 6 |
Total of all active and inactive participants | 2021-08-01 | 156 |
Number of employers contributing to the scheme | 2021-08-01 | 0 |
2020: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-08-01 | 148 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 159 |
Number of retired or separated participants receiving benefits | 2020-08-01 | 10 |
Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
Total of all active and inactive participants | 2020-08-01 | 169 |
Number of employers contributing to the scheme | 2020-08-01 | 0 |
2019: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-08-01 | 137 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 135 |
Number of retired or separated participants receiving benefits | 2019-08-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
Total of all active and inactive participants | 2019-08-01 | 140 |
Number of employers contributing to the scheme | 2019-08-01 | 0 |
2018: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-08-01 | 145 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 137 |
Number of retired or separated participants receiving benefits | 2018-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
Total of all active and inactive participants | 2018-08-01 | 140 |
Number of employers contributing to the scheme | 2018-08-01 | 0 |
2017: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-08-01 | 141 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 145 |
Number of retired or separated participants receiving benefits | 2017-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
Total of all active and inactive participants | 2017-08-01 | 145 |
Number of employers contributing to the scheme | 2017-08-01 | 0 |
2016: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-08-01 | 131 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 167 |
Number of retired or separated participants receiving benefits | 2016-08-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
Total of all active and inactive participants | 2016-08-01 | 168 |
2015: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-08-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 131 |
Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
Total of all active and inactive participants | 2015-08-01 | 131 |
2014: OLTMANS COMPANIES HEALTH AND WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-08-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 113 |
Number of retired or separated participants receiving benefits | 2014-08-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
Total of all active and inactive participants | 2014-08-01 | 119 |
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 805506G |
Policy instance | 5 |
Insurance contract or identification number | 805506G | Number of Individuals Covered | 141 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $2,574 | Total amount of fees paid to insurance company | USD $528 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $25,771 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,574 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
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AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 103835HNO |
Policy instance | 4 |
Insurance contract or identification number | 103835HNO | Number of Individuals Covered | 225 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $106,875 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,141,293 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $106,875 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 3 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 48 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $28,073 | Total amount of fees paid to insurance company | USD $4,757 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $568,099 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,073 | Amount paid for insurance broker fees | 4757 | Additional information about fees paid to insurance broker | 2022 PINNACLE MEDICAL RETENTION INCENTIVE RISK, INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-099 |
Policy instance | 2 |
Insurance contract or identification number | 850733-099 | Number of Individuals Covered | 179 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $9,761 | Total amount of fees paid to insurance company | USD $18 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $122,763 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $9,761 | Amount paid for insurance broker fees | 18 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 272 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $1,442 | Total amount of fees paid to insurance company | USD $109 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,295 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,442 | Amount paid for insurance broker fees | 109 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 |
Policy instance | 6 |
Insurance contract or identification number | 366594 | Number of Individuals Covered | 142 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $8,852 | Total amount of fees paid to insurance company | USD $1,907 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $95,352 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,852 | Amount paid for insurance broker fees | 1907 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 188 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $10,159 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $126,409 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $10,159 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 293 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $1,465 | Total amount of fees paid to insurance company | USD $112 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,599 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,465 | Amount paid for insurance broker fees | 112 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 3 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 46 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $26,596 | Total amount of fees paid to insurance company | USD $4,488 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $515,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,596 | Amount paid for insurance broker fees | 4488 | Additional information about fees paid to insurance broker | 2021 PINNACLE MEDICAL RETENTION INCENTIVE RISK, INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) |
Policy contract number | 103835HNO |
Policy instance | 4 |
Insurance contract or identification number | 103835HNO | Number of Individuals Covered | 244 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $105,721 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,050,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $105,721 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 805506G |
Policy instance | 5 |
Insurance contract or identification number | 805506G | Number of Individuals Covered | 149 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $2,833 | Total amount of fees paid to insurance company | USD $437 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $30,578 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,833 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 0001 |
Policy instance | 6 |
Insurance contract or identification number | 366594 0001 | Number of Individuals Covered | 150 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $9,820 | Total amount of fees paid to insurance company | USD $1,934 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $102,468 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,820 | Amount paid for insurance broker fees | 1934 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSTION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 122 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $1,282 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,956 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,282 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 304 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $1,534 | Total amount of fees paid to insurance company | USD $115 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,249 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,534 | Amount paid for insurance broker fees | 115 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-000 |
Policy instance | 3 |
Insurance contract or identification number | 850733-000 | Number of Individuals Covered | 214 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $11,028 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $136,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $11,028 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 4 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 54 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $34,522 | Total amount of fees paid to insurance company | USD $6,113 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $532,521 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,522 | Amount paid for insurance broker fees | 6113 | Additional information about fees paid to insurance broker | 2020 PINNACLE MEDICAL RETENTION ENHANCEMENT RISK 2020 PINNACLE MEDICAL RETENTION INCENTIVE RISK | Insurance broker organization code? | 3 |
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AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 103835HNO |
Policy instance | 5 |
Insurance contract or identification number | 103835HNO | Number of Individuals Covered | 265 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $136,724 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,096,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $136,724 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 805506G |
Policy instance | 6 |
Insurance contract or identification number | 805506G | Number of Individuals Covered | 156 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $2,852 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $26,244 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,852 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 0001 |
Policy instance | 7 |
Insurance contract or identification number | 366594 0001 | Number of Individuals Covered | 149 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $10,184 | Total amount of fees paid to insurance company | USD $1,670 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $95,420 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,184 | Amount paid for insurance broker fees | 1670 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 0001 |
Policy instance | 6 |
Insurance contract or identification number | 366594 0001 | Number of Individuals Covered | 146 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $11,106 | Total amount of fees paid to insurance company | USD $2,400 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $137,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,106 | Amount paid for insurance broker fees | 2400 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 103835HNO |
Policy instance | 5 |
Insurance contract or identification number | 103835HNO | Number of Individuals Covered | 289 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $137,274 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,133,734 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $137,274 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 4 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 163 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $32,960 | Total amount of fees paid to insurance company | USD $132 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $483,710 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,960 | Amount paid for insurance broker fees | 132 | Additional information about fees paid to insurance broker | INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733000 ET AL |
Policy instance | 3 |
Insurance contract or identification number | 850733000 ET AL | Number of Individuals Covered | 207 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $10,967 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $127,782 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $10,967 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734099 ET AL |
Policy instance | 2 |
Insurance contract or identification number | 850734099 ET AL | Number of Individuals Covered | 143 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $1,613 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,620 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,613 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 334 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $1,677 | Total amount of fees paid to insurance company | USD $257 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,953 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,677 | Amount paid for insurance broker fees | 257 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 318 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $1,636 | Total amount of fees paid to insurance company | USD $231 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,554 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,636 | Amount paid for insurance broker fees | 230 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 168 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $1,533 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,850 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,533 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 4 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 163 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $33,567 | Total amount of fees paid to insurance company | USD $138 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $500,912 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,567 | Amount paid for insurance broker fees | 138 | Additional information about fees paid to insurance broker | INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-000 |
Policy instance | 3 |
Insurance contract or identification number | 850733-000 | Number of Individuals Covered | 221 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $9,476 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $128,872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $9,476 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 103835HNO |
Policy instance | 5 |
Insurance contract or identification number | 103835HNO | Number of Individuals Covered | 287 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $130,367 | Total amount of fees paid to insurance company | USD $8,725 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,019,709 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $130,367 | Amount paid for insurance broker fees | 8725 | Additional information about fees paid to insurance broker | 2018 PREMIER PRODUCER MEDICAL RETENTION | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 0001 |
Policy instance | 6 |
Insurance contract or identification number | 366594 0001 | Number of Individuals Covered | 137 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $9,075 | Total amount of fees paid to insurance company | USD $1,753 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $110,641 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,075 | Amount paid for insurance broker fees | 1753 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 334 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $14,451 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,242 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-000 |
Policy instance | 3 |
Insurance contract or identification number | 850733-000 | Number of Individuals Covered | 195 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $10,664 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $124,664 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 103835 |
Policy instance | 4 |
Insurance contract or identification number | 103835 | Number of Individuals Covered | 171 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $28,669 | Total amount of fees paid to insurance company | USD $36,923 | Health Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $467,452 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | AGP-003221 |
Policy instance | 5 |
Insurance contract or identification number | AGP-003221 | Number of Individuals Covered | 8 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,598 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,656 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 154 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $1,926 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,308 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 366594 |
Policy instance | 6 |
Insurance contract or identification number | 366594 | Number of Individuals Covered | 154 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $8,923 | Total amount of fees paid to insurance company | USD $1,418 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $137,087 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 202847/366594 |
Policy instance | 4 |
Insurance contract or identification number | 202847/366594 | Number of Individuals Covered | 131 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $6,868 | Total amount of fees paid to insurance company | USD $782 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $76,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,868 | Amount paid for insurance broker fees | 782 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-099 |
Policy instance | 3 |
Insurance contract or identification number | 850733-099 | Number of Individuals Covered | 141 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $5,696 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $86,373 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $5,696 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 108 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $960 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $14,729 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $960 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 240 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $104,184 | Total amount of fees paid to insurance company | USD $1,544 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,603,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $104,184 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1544 | Additional information about fees paid to insurance broker | FEES | Insurance broker name | LOCKTON COMPANIES, LLC |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | C19937 |
Policy instance | 1 |
Insurance contract or identification number | C19937 | Number of Individuals Covered | 251 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $94,577 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,354,996 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $94,577 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 202847/366594 |
Policy instance | 5 |
Insurance contract or identification number | 202847/366594 | Number of Individuals Covered | 118 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $5,515 | Total amount of fees paid to insurance company | USD $533 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $56,399 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,515 | Amount paid for insurance broker fees | 533 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12019671 |
Policy instance | 4 |
Insurance contract or identification number | 12019671 | Number of Individuals Covered | 79 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $860 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,809 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $860 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 850733-099 |
Policy instance | 3 |
Insurance contract or identification number | 850733-099 | Number of Individuals Covered | 130 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $5,952 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $74,693 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $5,952 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 850734-099 |
Policy instance | 2 |
Insurance contract or identification number | 850734-099 | Number of Individuals Covered | 106 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $1,104 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,104 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
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