NIO USA, INC. has sponsored the creation of one or more 401k plans.
Additional information about NIO USA, INC.
Submission information for form 5500 for 401k plan NIO USA INC HEALTH & WELFARE PLAN
Measure | Date | Value |
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2022: NIO USA INC HEALTH & WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 207 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 218 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
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 | 218 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: NIO USA INC HEALTH & WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 193 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 197 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 5 |
Total of all active and inactive participants | 2021-01-01 | 207 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: NIO USA INC HEALTH & WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 385 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 191 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 8 |
Total of all active and inactive participants | 2020-01-01 | 203 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: NIO USA INC HEALTH & WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 649 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 376 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 9 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 113 |
Total of all active and inactive participants | 2019-01-01 | 498 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: NIO USA INC HEALTH & WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 441 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 639 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 7 |
Total of all active and inactive participants | 2018-01-01 | 649 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: NIO USA INC HEALTH & WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 288 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 431 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 3 |
Total of all active and inactive participants | 2017-01-01 | 441 |
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 633983 |
Policy instance | 5 |
Insurance contract or identification number | 633983 | Number of Individuals Covered | 249 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $150,591 | Total amount of fees paid to insurance company | USD $16,922 | Health Insurance Welfare Benefit | Yes | 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 | Welfare Benefit Premiums Paid to Carrier | USD $1,341,725 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $150,591 | Amount paid for insurance broker fees | 16922 | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION, GENERAL AGENT PAYMENTS | 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 | 694079 |
Policy instance | 4 |
Insurance contract or identification number | 694079 | Number of Individuals Covered | 218 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $20,467 | Total amount of fees paid to insurance company | USD $3,582 | 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, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $204,666 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,467 | Amount paid for insurance broker fees | 3582 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 3 |
Insurance contract or identification number | 713901 | Number of Individuals Covered | 100 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $33,569 | Total amount of fees paid to insurance company | USD $648 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $746,874 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,569 | Amount paid for insurance broker fees | 648 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 2 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2021-10-23 | Insurance policy end date | 2022-10-22 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 1 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 201 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,889 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $50,789 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,889 | 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 | 138368 |
Policy instance | 1 |
Insurance contract or identification number | 138368 | Number of Individuals Covered | 292 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $113,264 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,265,294 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $113,264 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 2 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 204 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,632 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,632 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 3 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2020-10-23 | Insurance policy end date | 2021-10-22 | Total amount of commissions paid to insurance broker | USD $948 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $9,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $948 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 4 |
Insurance contract or identification number | 713901 | Number of Individuals Covered | 106 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $35,162 | Total amount of fees paid to insurance company | USD $290 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $738,726 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,162 | Amount paid for insurance broker fees | 290 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 579305 |
Policy instance | 5 |
Insurance contract or identification number | 579305 | Number of Individuals Covered | 205 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $30,438 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $304,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,438 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SUTTER HEALTH AND AETNA INSURANCE (National Association of Insurance Commissioners NAIC id number: 15107 ) |
Policy contract number | 138368SH |
Policy instance | 6 |
Insurance contract or identification number | 138368SH | Number of Individuals Covered | 14 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,680 | 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 | 694079 |
Policy instance | 7 |
Insurance contract or identification number | 694079 | Number of Individuals Covered | 197 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $17,964 | Total amount of fees paid to insurance company | USD $3,593 | 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, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $179,634 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,964 | Amount paid for insurance broker fees | 3593 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 162060 |
Policy instance | 5 |
Insurance contract or identification number | 162060 | Number of Individuals Covered | 190 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $21,084 | Total amount of fees paid to insurance company | USD $13,892 | 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,EMPLOYEE ASSISTANCE PROGRAM | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,084 | Amount paid for insurance broker fees | 13892 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 4 |
Insurance contract or identification number | 713901 | 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 $41,831 | Total amount of fees paid to insurance company | USD $1,812 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $780,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $41,831 | Amount paid for insurance broker fees | 1812 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 3 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2019-10-23 | Insurance policy end date | 2020-10-22 | Total amount of commissions paid to insurance broker | USD $1,430 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,430 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 2 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 191 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,858 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,858 | 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 | 138368 |
Policy instance | 1 |
Insurance contract or identification number | 138368 | Number of Individuals Covered | 419 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $150,909 | Total amount of fees paid to insurance company | USD $16,000 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,713,730 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $150,909 | Amount paid for insurance broker fees | 16000 | Additional information about fees paid to insurance broker | 2019 PPP SPECIALTY NEW BUSINESS RISK | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 162060 |
Policy instance | 5 |
Insurance contract or identification number | 162060 | Number of Individuals Covered | 385 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $76,026 | Total amount of fees paid to insurance company | USD $14,440 | 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,EMPLOYEE ASSISTANCE PROGRAM | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $76,026 | Amount paid for insurance broker fees | 14440 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 4 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2018-10-23 | Insurance policy end date | 2019-10-22 | Total amount of commissions paid to insurance broker | USD $1,430 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $28,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,430 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 3 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 422 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $3,101 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $162,586 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,101 | 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 | 138368 |
Policy instance | 2 |
Insurance contract or identification number | 138368 | Number of Individuals Covered | 927 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $335,582 | Total amount of fees paid to insurance company | USD $11,812 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,715,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $335,582 | Amount paid for insurance broker fees | 11812 | Additional information about fees paid to insurance broker | CA DEC 19 LOCAL MARKET BONUS INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 1 |
Insurance contract or identification number | 713901 | Number of Individuals Covered | 245 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $89,534 | Total amount of fees paid to insurance company | USD $5,749 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,914,927 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $89,534 | Amount paid for insurance broker fees | 5749 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 1 |
Insurance contract or identification number | 713901 | Number of Individuals Covered | 342 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $69,722 | Total amount of fees paid to insurance company | USD $4,735 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,403,297 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $69,722 | Amount paid for insurance broker fees | 4735 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 0616695 |
Policy instance | 2 |
Insurance contract or identification number | 0616695 | Number of Individuals Covered | 617 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $77,188 | Total amount of fees paid to insurance company | USD $1,100 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $776,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $77,188 | Amount paid for insurance broker fees | 1100 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 3 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 632 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,046 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $143,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $3,046 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 4 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2017-10-23 | Insurance policy end date | 2018-10-22 | Total amount of commissions paid to insurance broker | USD $1,430 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $14,300 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $1,430 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 162060 |
Policy instance | 5 |
Insurance contract or identification number | 162060 | Number of Individuals Covered | 431 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $16,893 | Total amount of fees paid to insurance company | USD $10,177 | 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,EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,893 | Amount paid for insurance broker fees | 10177 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 426 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $31,729 | Total amount of fees paid to insurance company | USD $8,034 | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,729 | Amount paid for insurance broker fees | 8034 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ABD INS. AND FINANCIAL SVCS., INC. |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 06971A |
Policy instance | 4 |
Insurance contract or identification number | 06971A | Number of Individuals Covered | 1 | Insurance policy start date | 2016-10-23 | Insurance policy end date | 2017-10-22 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 30061306 |
Policy instance | 3 |
Insurance contract or identification number | 30061306 | Number of Individuals Covered | 428 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,587 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $87,254 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,587 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | ABD INS. AND FINANCIAL SVCS., INC. |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 0616695 |
Policy instance | 2 |
Insurance contract or identification number | 0616695 | Number of Individuals Covered | 425 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $56,888 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $571,886 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $56,888 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | ABD INS. AND FINANCIAL SVCS., INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 713901 |
Policy instance | 1 |
Insurance contract or identification number | 713901 | Number of Individuals Covered | 242 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $57,746 | Total amount of fees paid to insurance company | USD $3,249 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $954,033 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,263 | Amount paid for insurance broker fees | 3249 | Additional information about fees paid to insurance broker | BONUS NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | WARNER PACIFIC INSURANCE SERVICES |
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