BAYSHORE FORD TRUCK SALES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BAYSHORE FORD HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2021: BAYSHORE FORD HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-12-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 100 |
Number of retired or separated participants receiving benefits | 2021-12-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
Total of all active and inactive participants | 2021-12-01 | 101 |
2020: BAYSHORE FORD HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-12-01 | 121 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 114 |
Number of retired or separated participants receiving benefits | 2020-12-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
Total of all active and inactive participants | 2020-12-01 | 115 |
2019: BAYSHORE FORD HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-12-01 | 128 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 125 |
Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
Total of all active and inactive participants | 2019-12-01 | 125 |
2018: BAYSHORE FORD HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-12-01 | 150 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 149 |
Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
Total of all active and inactive participants | 2018-12-01 | 149 |
2017: BAYSHORE FORD HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-12-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 120 |
Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
Total of all active and inactive participants | 2017-12-01 | 120 |
2016: BAYSHORE FORD HEALTH AND WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-12-01 | 127 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 120 |
Number of retired or separated participants receiving benefits | 2016-12-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 0 |
Total of all active and inactive participants | 2016-12-01 | 122 |
2015: BAYSHORE FORD HEALTH AND WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-12-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 127 |
Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
Total of all active and inactive participants | 2015-12-01 | 127 |
2014: BAYSHORE FORD HEALTH AND WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-12-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 110 |
Number of retired or separated participants receiving benefits | 2014-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
Total of all active and inactive participants | 2014-12-01 | 110 |
2013: BAYSHORE FORD HEALTH AND WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-12-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 107 |
Number of retired or separated participants receiving benefits | 2013-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
Total of all active and inactive participants | 2013-12-01 | 107 |
2021: BAYSHORE FORD HEALTH AND WELFARE PLAN 2021 form 5500 responses |
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2021-12-01 | Type of plan entity | Mulitple employer plan |
2021-12-01 | Submission has been amended | No |
2021-12-01 | This submission is the final filing | No |
2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-12-01 | Plan is a collectively bargained plan | No |
2021-12-01 | Plan funding arrangement – Insurance | Yes |
2021-12-01 | Plan benefit arrangement – Insurance | Yes |
2020: BAYSHORE FORD HEALTH AND WELFARE PLAN 2020 form 5500 responses |
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2020-12-01 | Type of plan entity | Mulitple employer plan |
2020-12-01 | Submission has been amended | No |
2020-12-01 | This submission is the final filing | No |
2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-12-01 | Plan is a collectively bargained plan | No |
2020-12-01 | Plan funding arrangement – Insurance | Yes |
2020-12-01 | Plan benefit arrangement – Insurance | Yes |
2019: BAYSHORE FORD HEALTH AND WELFARE PLAN 2019 form 5500 responses |
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2019-12-01 | Type of plan entity | Mulitple employer plan |
2019-12-01 | Submission has been amended | No |
2019-12-01 | This submission is the final filing | No |
2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-12-01 | Plan is a collectively bargained plan | No |
2019-12-01 | Plan funding arrangement – Insurance | Yes |
2019-12-01 | Plan benefit arrangement – Insurance | Yes |
2018: BAYSHORE FORD HEALTH AND WELFARE PLAN 2018 form 5500 responses |
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2018-12-01 | Type of plan entity | Mulitple employer plan |
2018-12-01 | Submission has been amended | No |
2018-12-01 | This submission is the final filing | No |
2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-12-01 | Plan is a collectively bargained plan | No |
2018-12-01 | Plan funding arrangement – Insurance | Yes |
2018-12-01 | Plan benefit arrangement – Insurance | Yes |
2017: BAYSHORE FORD HEALTH AND WELFARE PLAN 2017 form 5500 responses |
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2017-12-01 | Type of plan entity | Mulitple employer plan |
2017-12-01 | Submission has been amended | No |
2017-12-01 | This submission is the final filing | No |
2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-12-01 | Plan is a collectively bargained plan | No |
2017-12-01 | Plan funding arrangement – Insurance | Yes |
2017-12-01 | Plan benefit arrangement – Insurance | Yes |
2016: BAYSHORE FORD HEALTH AND WELFARE PLAN 2016 form 5500 responses |
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2016-12-01 | Type of plan entity | Mulitple employer plan |
2016-12-01 | Submission has been amended | No |
2016-12-01 | This submission is the final filing | No |
2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-12-01 | Plan is a collectively bargained plan | No |
2016-12-01 | Plan funding arrangement – Insurance | Yes |
2016-12-01 | Plan benefit arrangement – Insurance | Yes |
2015: BAYSHORE FORD HEALTH AND WELFARE PLAN 2015 form 5500 responses |
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2015-12-01 | Type of plan entity | Mulitple employer plan |
2015-12-01 | Submission has been amended | No |
2015-12-01 | This submission is the final filing | No |
2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-12-01 | Plan is a collectively bargained plan | No |
2015-12-01 | Plan funding arrangement – Insurance | Yes |
2015-12-01 | Plan benefit arrangement – Insurance | Yes |
2014: BAYSHORE FORD HEALTH AND WELFARE PLAN 2014 form 5500 responses |
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2014-12-01 | Type of plan entity | Mulitple employer plan |
2014-12-01 | Submission has been amended | No |
2014-12-01 | This submission is the final filing | No |
2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-12-01 | Plan is a collectively bargained plan | No |
2014-12-01 | Plan funding arrangement – Insurance | Yes |
2014-12-01 | Plan benefit arrangement – Insurance | Yes |
2013: BAYSHORE FORD HEALTH AND WELFARE PLAN 2013 form 5500 responses |
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2013-12-01 | Type of plan entity | Single employer plan |
2013-12-01 | First time form 5500 has been submitted | Yes |
2013-12-01 | Submission has been amended | No |
2013-12-01 | This submission is the final filing | No |
2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-12-01 | Plan is a collectively bargained plan | No |
2013-12-01 | Plan funding arrangement – Insurance | Yes |
2013-12-01 | Plan benefit arrangement – Insurance | Yes |
BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 231575 |
Policy instance | 4 |
Insurance contract or identification number | 231575 | Number of Individuals Covered | 79 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $54,845 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | 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 $1,265,768 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,845 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0AVDN |
Policy instance | 3 |
Insurance contract or identification number | GUC 0AVDN | Number of Individuals Covered | 41 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $1,833 | Total amount of fees paid to insurance company | USD $791 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $18,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,833 | Amount paid for insurance broker fees | 791 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AVDN |
Policy instance | 2 |
Insurance contract or identification number | GVTL0AVDN | Number of Individuals Covered | 30 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $1,589 | Total amount of fees paid to insurance company | USD $989 | Are there contracts with allocated funds for individual policies? | 0 | 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 | 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 $15,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,589 | Amount paid for insurance broker fees | 989 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AVDN |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AVDN | Number of Individuals Covered | 100 | Insurance policy start date | 2021-12-01 | Insurance policy end date | 2022-11-30 | Total amount of commissions paid to insurance broker | USD $560 | Total amount of fees paid to insurance company | USD $356 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $5,597 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $560 | Amount paid for insurance broker fees | 356 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AVDN |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AVDN | Number of Individuals Covered | 114 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $594 | Total amount of fees paid to insurance company | USD $354 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $5,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $594 | Amount paid for insurance broker fees | 340 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AVDN |
Policy instance | 2 |
Insurance contract or identification number | GVTL0AVDN | Number of Individuals Covered | 27 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $1,638 | Total amount of fees paid to insurance company | USD $977 | Are there contracts with allocated funds for individual policies? | 0 | 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 | 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 $16,380 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,638 | Amount paid for insurance broker fees | 939 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0AVDN |
Policy instance | 3 |
Insurance contract or identification number | GUC 0AVDN | Number of Individuals Covered | 40 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $1,326 | Total amount of fees paid to insurance company | USD $1,025 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $13,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,326 | Amount paid for insurance broker fees | 984 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 231575 |
Policy instance | 4 |
Insurance contract or identification number | 231575 | Number of Individuals Covered | 84 | Insurance policy start date | 2020-12-01 | Insurance policy end date | 2021-11-30 | Total amount of commissions paid to insurance broker | USD $46,067 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | 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 $939,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $46,067 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 231575 |
Policy instance | 4 |
Insurance contract or identification number | 231575 | Number of Individuals Covered | 84 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $48,332 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | 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 $1,116,497 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,332 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0AVDN |
Policy instance | 3 |
Insurance contract or identification number | GUC 0AVDN | Number of Individuals Covered | 37 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $1,639 | Total amount of fees paid to insurance company | USD $1,495 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $16,393 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,639 | Amount paid for insurance broker fees | 1003 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AVDN |
Policy instance | 2 |
Insurance contract or identification number | GVTL0AVDN | Number of Individuals Covered | 24 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $1,578 | Total amount of fees paid to insurance company | USD $1,405 | Are there contracts with allocated funds for individual policies? | 0 | 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 | 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 $15,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,578 | Amount paid for insurance broker fees | 932 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AVDN |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AVDN | Number of Individuals Covered | 125 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-11-30 | Total amount of commissions paid to insurance broker | USD $567 | Total amount of fees paid to insurance company | USD $519 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $5,669 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 170 | Additional information about fees paid to insurance broker | ADMINISTRATION | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $567 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AVDN |
Policy instance | 2 |
Insurance contract or identification number | GVTL0AVDN | Number of Individuals Covered | 24 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $1,550 | Total amount of fees paid to insurance company | USD $2,104 | Are there contracts with allocated funds for individual policies? | 0 | 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 | 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 $15,497 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,550 | Amount paid for insurance broker fees | 1405 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0AVDN |
Policy instance | 3 |
Insurance contract or identification number | GUC 0AVDN | Number of Individuals Covered | 36 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $1,672 | Total amount of fees paid to insurance company | USD $1,511 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $16,715 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,672 | Amount paid for insurance broker fees | 866 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 231575 |
Policy instance | 4 |
Insurance contract or identification number | 231575 | Number of Individuals Covered | 87 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $48,519 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | 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 $1,212,654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,519 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AVDN |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AVDN | Number of Individuals Covered | 127 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $586 | Total amount of fees paid to insurance company | USD $792 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $5,857 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $586 | Amount paid for insurance broker fees | 528 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AVDN |
Policy instance | 2 |
Insurance contract or identification number | GVTL0AVDN | Number of Individuals Covered | 26 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,606 | Total amount of fees paid to insurance company | USD $968 | Are there contracts with allocated funds for individual policies? | 0 | 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 | 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 $16,064 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUC 0AVDN |
Policy instance | 3 |
Insurance contract or identification number | GUC 0AVDN | Number of Individuals Covered | 26 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $943 | Total amount of fees paid to insurance company | USD $701 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $9,429 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 02558381 |
Policy instance | 4 |
Insurance contract or identification number | 02558381 | Number of Individuals Covered | 81 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $44,822 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | 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 | Yes | 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 $1,130,133 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AVDN |
Policy instance | 1 |
Insurance contract or identification number | GLUG0AVDN | Number of Individuals Covered | 123 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $582 | Total amount of fees paid to insurance company | USD $338 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 $5,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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