JIM KOONS MANAGEMENT CO., INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN
401k plan membership statisitcs for JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2021: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 2,310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 2,321 |
| Total of all active and inactive participants | 2021-11-01 | 2,321 |
| 2020: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 2,059 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 2,310 |
| Total of all active and inactive participants | 2020-11-01 | 2,310 |
| 2019: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 2,112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 2,059 |
| Total of all active and inactive participants | 2019-11-01 | 2,059 |
| 2018: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 2,105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 2,112 |
| Total of all active and inactive participants | 2018-11-01 | 2,112 |
| 2017: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 2,118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 2,105 |
| Total of all active and inactive participants | 2017-11-01 | 2,105 |
| 2016: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 2,046 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 2,118 |
| Total of all active and inactive participants | 2016-11-01 | 2,118 |
| 2015: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 1,910 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 2,046 |
| Total of all active and inactive participants | 2015-11-01 | 2,046 |
| 2014: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 1,887 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 1,910 |
| Total of all active and inactive participants | 2014-11-01 | 1,910 |
| 2013: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 1,729 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 1,887 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 1,887 |
| Total participants | 2013-11-01 | 0 |
| 2012: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 1,655 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 1,729 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 1,729 |
| 2011: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 1,586 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 1,655 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 0 |
| Total of all active and inactive participants | 2011-11-01 | 1,655 |
| 2010: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 1,685 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 1,586 |
| Number of retired or separated participants receiving benefits | 2010-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-11-01 | 0 |
| Total of all active and inactive participants | 2010-11-01 | 1,586 |
| Total participants, beginning-of-year | 2010-03-01 | 1,558 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 1,685 |
| Number of retired or separated participants receiving benefits | 2010-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-03-01 | 0 |
| Total of all active and inactive participants | 2010-03-01 | 1,685 |
| 2009: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 1,477 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 1,558 |
| Number of retired or separated participants receiving benefits | 2009-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-03-01 | 0 |
| Total of all active and inactive participants | 2009-03-01 | 1,558 |
| 2008: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-03-01 | 1,374 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-03-01 | 1,477 |
| Number of retired or separated participants receiving benefits | 2008-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-03-01 | 0 |
| Total of all active and inactive participants | 2008-03-01 | 1,477 |
| 2007: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-03-01 | 1,893 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-03-01 | 1,374 |
| Number of retired or separated participants receiving benefits | 2007-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-03-01 | 0 |
| Total of all active and inactive participants | 2007-03-01 | 1,374 |
| 2006: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-03-01 | 1,989 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-03-01 | 1,893 |
| Number of retired or separated participants receiving benefits | 2006-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-03-01 | 0 |
| Total of all active and inactive participants | 2006-03-01 | 1,893 |
| 2005: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-03-01 | 2,156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-03-01 | 1,989 |
| Number of retired or separated participants receiving benefits | 2005-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-03-01 | 0 |
| Total of all active and inactive participants | 2005-03-01 | 1,989 |
| 2004: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-03-01 | 2,209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-03-01 | 2,156 |
| Number of retired or separated participants receiving benefits | 2004-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-03-01 | 0 |
| Total of all active and inactive participants | 2004-03-01 | 2,156 |
| 2003: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-03-01 | 2,209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-03-01 | 2,209 |
| Number of retired or separated participants receiving benefits | 2003-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-03-01 | 0 |
| Total of all active and inactive participants | 2003-03-01 | 2,209 |
| 2002: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-03-01 | 793 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-03-01 | 2,209 |
| Number of retired or separated participants receiving benefits | 2002-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-03-01 | 0 |
| Total of all active and inactive participants | 2002-03-01 | 2,209 |
| 2021: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Submission has been amended | No |
| 2010-11-01 | This submission is the final filing | No |
| 2010-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-11-01 | Plan is a collectively bargained plan | No |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-03-01 | Type of plan entity | Single employer plan |
| 2010-03-01 | Submission has been amended | No |
| 2010-03-01 | This submission is the final filing | No |
| 2010-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2010-03-01 | Plan is a collectively bargained plan | No |
| 2010-03-01 | Plan funding arrangement – Insurance | Yes |
| 2010-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | Submission has been amended | No |
| 2009-03-01 | This submission is the final filing | No |
| 2009-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-03-01 | Plan is a collectively bargained plan | No |
| 2009-03-01 | Plan funding arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2008 form 5500 responses |
|---|
| 2008-03-01 | Type of plan entity | Single employer plan |
| 2008-03-01 | Submission has been amended | No |
| 2008-03-01 | This submission is the final filing | No |
| 2008-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-03-01 | Plan is a collectively bargained plan | No |
| 2008-03-01 | Plan funding arrangement – Insurance | Yes |
| 2008-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2007 form 5500 responses |
|---|
| 2007-03-01 | Type of plan entity | Single employer plan |
| 2007-03-01 | Submission has been amended | No |
| 2007-03-01 | This submission is the final filing | No |
| 2007-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-03-01 | Plan is a collectively bargained plan | No |
| 2007-03-01 | Plan funding arrangement – Insurance | Yes |
| 2007-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2006 form 5500 responses |
|---|
| 2006-03-01 | Type of plan entity | Single employer plan |
| 2006-03-01 | Submission has been amended | No |
| 2006-03-01 | This submission is the final filing | No |
| 2006-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-03-01 | Plan is a collectively bargained plan | No |
| 2006-03-01 | Plan funding arrangement – Insurance | Yes |
| 2006-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2005 form 5500 responses |
|---|
| 2005-03-01 | Type of plan entity | Single employer plan |
| 2005-03-01 | Submission has been amended | No |
| 2005-03-01 | This submission is the final filing | No |
| 2005-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-03-01 | Plan is a collectively bargained plan | No |
| 2005-03-01 | Plan funding arrangement – Insurance | Yes |
| 2005-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2004 form 5500 responses |
|---|
| 2004-03-01 | Type of plan entity | Single employer plan |
| 2004-03-01 | Submission has been amended | No |
| 2004-03-01 | This submission is the final filing | No |
| 2004-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-03-01 | Plan is a collectively bargained plan | No |
| 2004-03-01 | Plan funding arrangement – Insurance | Yes |
| 2004-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2003 form 5500 responses |
|---|
| 2003-03-01 | Type of plan entity | Single employer plan |
| 2003-03-01 | Submission has been amended | No |
| 2003-03-01 | This submission is the final filing | No |
| 2003-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-03-01 | Plan is a collectively bargained plan | No |
| 2003-03-01 | Plan funding arrangement – Insurance | Yes |
| 2003-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: JIM KOONS MANAGEMENT CO., INC. FLEXIBLE BENEFITS PLAN 2002 form 5500 responses |
|---|
| 2002-03-01 | Type of plan entity | Single employer plan |
| 2002-03-01 | Submission has been amended | No |
| 2002-03-01 | This submission is the final filing | No |
| 2002-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-03-01 | Plan is a collectively bargained plan | No |
| 2002-03-01 | Plan funding arrangement – Insurance | Yes |
| 2002-03-01 | Plan benefit arrangement – Insurance | Yes |
| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 892460 |
| Policy instance | 5 |
| Insurance contract or identification number | 892460 | | Number of Individuals Covered | 2444 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $30,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
| Policy contract number | 179403 |
| Policy instance | 4 |
| Insurance contract or identification number | 179403 | | Number of Individuals Covered | 1135 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $56,209 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $468,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,209 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681132G |
| Policy instance | 3 |
| Insurance contract or identification number | 681132G | | Number of Individuals Covered | 1026 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $182,850 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WD-FLEX | | Welfare Benefit Premiums Paid to Carrier | USD $1,029,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $182,850 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 730498 |
| Policy instance | 2 |
| Insurance contract or identification number | 730498 | | Number of Individuals Covered | 2321 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $521,500 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,287,497 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $521,500 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5127185 |
| Policy instance | 1 |
| Insurance contract or identification number | 5127185 | | Number of Individuals Covered | 2013 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $25,530 | | Total amount of fees paid to insurance company | USD $58 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $147,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,530 | | Amount paid for insurance broker fees | 58 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 730498 |
| Policy instance | 2 |
| Insurance contract or identification number | 730498 | | Number of Individuals Covered | 2310 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $423,000 | | Total amount of fees paid to insurance company | USD $50,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,201,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $423,000 | | Amount paid for insurance broker fees | 50000 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681132G |
| Policy instance | 3 |
| Insurance contract or identification number | 681132G | | Number of Individuals Covered | 986 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $159,427 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WD-FLEX | | Welfare Benefit Premiums Paid to Carrier | USD $887,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $159,427 | | Insurance broker organization code? | 3 |
|
| DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
| Policy contract number | 179403 |
| Policy instance | 4 |
| Insurance contract or identification number | 179403 | | Number of Individuals Covered | 1128 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $47,422 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $429,091 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,422 |
|
| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 892460 |
| Policy instance | 5 |
| Insurance contract or identification number | 892460 | | Number of Individuals Covered | 2579 | | 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 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $21,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5127185 |
| Policy instance | 1 |
| Insurance contract or identification number | 5127185 | | Number of Individuals Covered | 1953 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $21,487 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $134,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,487 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681132G |
| Policy instance | 3 |
| Insurance contract or identification number | 681132G | | Number of Individuals Covered | 905 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $149,661 | | Total amount of fees paid to insurance company | USD $4,153 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WD-FLEX | | Welfare Benefit Premiums Paid to Carrier | USD $815,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $149,661 | | Amount paid for insurance broker fees | 4153 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5127185 |
| Policy instance | 1 |
| Insurance contract or identification number | 5127185 | | Number of Individuals Covered | 1716 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $21,098 | | Total amount of fees paid to insurance company | USD $69 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $122,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,098 | | Amount paid for insurance broker fees | 69 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 730498 |
| Policy instance | 2 |
| Insurance contract or identification number | 730498 | | Number of Individuals Covered | 2059 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $432,000 | | Total amount of fees paid to insurance company | USD $25,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,610,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $432,000 | | Amount paid for insurance broker fees | 25000 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 730498 |
| Policy instance | 2 |
| Insurance contract or identification number | 730498 | | Number of Individuals Covered | 2112 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $432,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,613,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 432000 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05127185 |
| Policy instance | 1 |
| Insurance contract or identification number | TS05127185 | | Number of Individuals Covered | 1732 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $21,425 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $128,193 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,425 | | Insurance broker organization code? | 3 |
|
| DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
| Policy contract number | 179403 |
| Policy instance | 3 |
| Insurance contract or identification number | 179403 | | Number of Individuals Covered | 1051 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $39,492 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $410,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 39492 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681132G |
| Policy instance | 4 |
| Insurance contract or identification number | 681132G | | Number of Individuals Covered | 957 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $147,389 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WD - FLEX | | Welfare Benefit Premiums Paid to Carrier | USD $807,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $147,389 | | Insurance broker organization code? | 3 |
|
| DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) |
| Policy contract number | 179403 |
| Policy instance | 3 |
| Insurance contract or identification number | 179403 | | Number of Individuals Covered | 1013 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $39,125 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $393,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681132G |
| Policy instance | 4 |
| Insurance contract or identification number | 681132G | | Number of Individuals Covered | 907 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $134,565 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | WD - FLEX | | Welfare Benefit Premiums Paid to Carrier | USD $740,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05127185 |
| Policy instance | 1 |
| Insurance contract or identification number | TS05127185 | | Number of Individuals Covered | 1632 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $20,163 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $116,646 | | 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 number | 730498 |
| Policy instance | 2 |
| Insurance contract or identification number | 730498 | | Number of Individuals Covered | 2105 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $384,000 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,750,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
