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COTTONWOOD, INC. HEALTH INSURANCE PLAN 401k Plan overview

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

COTTONWOOD, INC. HEALTH INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

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

Company Name:COTTONWOOD, INC.
Employer identification number (EIN):480780431
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01JESSICA WOOD2023-07-07
5022021-01-01JESSICA WOOD2022-07-06
5022019-01-01
5022018-01-01
5022017-01-01YVONNE BROWNELL
5022016-01-01YVONNE G. BROWNELL
5022015-01-01YVONNE G. BROWNELL
5022014-01-01YVONNE BROWNELL
5022013-01-01YVONNE G. BROWNELL
5022012-01-01ALAN W. GROESBECK
5022011-01-01ALAN W GROESBECK
5022009-01-01BARBARA BLEVINS

Plan Statistics for COTTONWOOD, INC. HEALTH INSURANCE PLAN

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

Measure Date Value
2022: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01137
Total number of active participants reported on line 7a of the Form 55002022-01-01140
Number of retired or separated participants receiving benefits2022-01-011
Total of all active and inactive participants2022-01-01141
2021: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01169
Total number of active participants reported on line 7a of the Form 55002021-01-01137
Number of retired or separated participants receiving benefits2021-01-012
Total of all active and inactive participants2021-01-01139
2019: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01181
Total number of active participants reported on line 7a of the Form 55002019-01-01176
Number of retired or separated participants receiving benefits2019-01-012
Total of all active and inactive participants2019-01-01178
Total participants2019-01-01178
Number of participants with account balances2019-01-010
2018: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01170
Total number of active participants reported on line 7a of the Form 55002018-01-01179
Number of retired or separated participants receiving benefits2018-01-012
Total of all active and inactive participants2018-01-01181
Total participants2018-01-01181
2017: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01170
Total number of active participants reported on line 7a of the Form 55002017-01-01169
Number of retired or separated participants receiving benefits2017-01-011
Total of all active and inactive participants2017-01-01170
Total participants2017-01-01170
2016: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01198
Total number of active participants reported on line 7a of the Form 55002016-01-01166
Number of retired or separated participants receiving benefits2016-01-014
Total of all active and inactive participants2016-01-01170
Total participants2016-01-01170
2015: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01189
Total number of active participants reported on line 7a of the Form 55002015-01-01195
Number of retired or separated participants receiving benefits2015-01-013
Total of all active and inactive participants2015-01-01198
Total participants2015-01-010
2014: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01196
Total number of active participants reported on line 7a of the Form 55002014-01-01185
Number of retired or separated participants receiving benefits2014-01-014
Total of all active and inactive participants2014-01-01189
Total participants2014-01-010
2013: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0158
Total number of active participants reported on line 7a of the Form 55002013-01-01191
Number of retired or separated participants receiving benefits2013-01-015
Total of all active and inactive participants2013-01-01196
Total participants2013-01-010
2012: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0150
Total number of active participants reported on line 7a of the Form 55002012-01-0158
Total of all active and inactive participants2012-01-0158
Total participants2012-01-010
2011: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0148
Total number of active participants reported on line 7a of the Form 55002011-01-0150
Total of all active and inactive participants2011-01-0150
Total participants2011-01-0150
2009: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01123
Total number of active participants reported on line 7a of the Form 55002009-01-01114
Total of all active and inactive participants2009-01-01114
Total participants2009-01-01114

Form 5500 Responses for COTTONWOOD, INC. HEALTH INSURANCE PLAN

2022: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2019: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0175933
Policy instance 4
Insurance contract or identification number0175933
Number of Individuals Covered168
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8,880
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $926,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees8880
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number54359-000-00001
Policy instance 3
Insurance contract or identification number54359-000-00001
Number of Individuals Covered37
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,738
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,738
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered111
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,458
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,458
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98649191001
Policy instance 1
Insurance contract or identification number98649191001
Number of Individuals Covered211
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,397
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,397
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98649191001
Policy instance 1
Insurance contract or identification number98649191001
Number of Individuals Covered220
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,703
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,703
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered101
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,945
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,945
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number54359-000-00001
Policy instance 3
Insurance contract or identification number54359-000-00001
Number of Individuals Covered48
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,246
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,246
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )
Policy contract number07729
Policy instance 4
Insurance contract or identification number07729
Number of Individuals Covered170
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $21,719
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,719
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 5
Insurance contract or identification number51359-000-00001
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98649191001
Policy instance 1
Insurance contract or identification number98649191001
Number of Individuals Covered234
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,610
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,610
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered107
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,851
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,851
Insurance broker organization code?3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number54359-000-00001
Policy instance 3
Insurance contract or identification number54359-000-00001
Number of Individuals Covered54
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,538
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,538
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0108847
Policy instance 4
Insurance contract or identification number0108847
Number of Individuals Covered194
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $39,097
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,060,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,097
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )
Policy contract number09517
Policy instance 3
Insurance contract or identification number09517
Number of Individuals Covered199
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered167
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,221
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,221
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98649191001
Policy instance 1
Insurance contract or identification number98649191001
Number of Individuals Covered238
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,702
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,702
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )
Policy contract number09517
Policy instance 3
Insurance contract or identification number09517
Number of Individuals Covered216
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered171
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,444
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,444
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98649191001
Policy instance 1
Insurance contract or identification number98649191001
Number of Individuals Covered237
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,683
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,683
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9864919
Policy instance 1
Insurance contract or identification number9864919
Number of Individuals Covered221
Total amount of commissions paid to insurance brokerUSD $1,595
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,595
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered170
Total amount of commissions paid to insurance brokerUSD $5,937
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,937
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number5051150000
Policy instance 3
Insurance contract or identification number5051150000
Number of Individuals Covered194
Total amount of commissions paid to insurance brokerUSD $16,765
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $917,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,765
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number5051150000
Policy instance 3
Insurance contract or identification number5051150000
Number of Individuals Covered197
Total amount of commissions paid to insurance brokerUSD $23,428
Total amount of fees paid to insurance companyUSD $15,226
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $780,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,428
Amount paid for insurance broker fees15226
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9864919
Policy instance 1
Insurance contract or identification number9864919
Number of Individuals Covered231
Total amount of commissions paid to insurance brokerUSD $1,495
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,495
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered169
Total amount of commissions paid to insurance brokerUSD $5,766
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,766
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered169
Total amount of commissions paid to insurance brokerUSD $4,914
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,914
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9864919
Policy instance 1
Insurance contract or identification number9864919
Number of Individuals Covered232
Total amount of commissions paid to insurance brokerUSD $1,626
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,626
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number5051150000
Policy instance 3
Insurance contract or identification number5051150000
Number of Individuals Covered201
Total amount of commissions paid to insurance brokerUSD $30,286
Total amount of fees paid to insurance companyUSD $14,567
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $757,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,286
Amount paid for insurance broker fees14567
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12249479
Policy instance 3
Insurance contract or identification number12249479
Number of Individuals Covered178
Total amount of commissions paid to insurance brokerUSD $1,140
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,485
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,140
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered179
Total amount of commissions paid to insurance brokerUSD $5,791
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,791
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number5051150000
Policy instance 1
Insurance contract or identification number5051150000
Number of Individuals Covered203
Total amount of commissions paid to insurance brokerUSD $29,071
Total amount of fees paid to insurance companyUSD $10,390
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $726,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,071
Amount paid for insurance broker fees10390
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBUKATY COMPANIES
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number5051150000
Policy instance 1
Insurance contract or identification number5051150000
Number of Individuals Covered213
Total amount of commissions paid to insurance brokerUSD $33,822
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $845,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 2
Insurance contract or identification number51359-000-00001
Number of Individuals Covered188
Total amount of commissions paid to insurance brokerUSD $5,674
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12249479
Policy instance 3
Insurance contract or identification number12249479
Number of Individuals Covered190
Total amount of commissions paid to insurance brokerUSD $1,161
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number51359-000-00001
Policy instance 1
Insurance contract or identification number51359-000-00001
Number of Individuals Covered185
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,288
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12249479
Policy instance 2
Insurance contract or identification number12249479
Number of Individuals Covered189
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,184
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0707145
Policy instance 3
Insurance contract or identification number0707145
Number of Individuals Covered213
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $28,689
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $764,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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