MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE
401k plan membership statisitcs for MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE
Measure | Date | Value |
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2021: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2021 401k membership |
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Total participants, beginning-of-year | 2021-07-01 | 97 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 70 |
Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
Total of all active and inactive participants | 2021-07-01 | 70 |
2020: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2020 401k membership |
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Total participants, beginning-of-year | 2020-07-01 | 101 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 97 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
Total of all active and inactive participants | 2020-07-01 | 97 |
2019: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 88 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 78 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 78 |
2018: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2018 401k membership |
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Total participants, beginning-of-year | 2018-07-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 87 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 1 |
Total of all active and inactive participants | 2018-07-01 | 88 |
2017: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 112 |
Total of all active and inactive participants | 2017-07-01 | 112 |
2006: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2006 401k membership |
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Total participants, beginning-of-year | 2006-07-01 | 82 |
Total number of active participants reported on line 7a of the Form 5500 | 2006-07-01 | 82 |
Total of all active and inactive participants | 2006-07-01 | 82 |
2005: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2005 401k membership |
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Total participants, beginning-of-year | 2005-07-01 | 164 |
Total number of active participants reported on line 7a of the Form 5500 | 2005-07-01 | 164 |
Total of all active and inactive participants | 2005-07-01 | 164 |
2004: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2004 401k membership |
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Total participants, beginning-of-year | 2004-07-01 | 138 |
Total number of active participants reported on line 7a of the Form 5500 | 2004-07-01 | 138 |
Number of retired or separated participants receiving benefits | 2004-07-01 | 0 |
Total of all active and inactive participants | 2004-07-01 | 138 |
2021: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2021 form 5500 responses |
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2021-07-01 | Type of plan entity | Single employer plan |
2021-07-01 | Submission has been amended | No |
2021-07-01 | This submission is the final filing | No |
2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-07-01 | Plan is a collectively bargained plan | No |
2021-07-01 | Plan funding arrangement – Insurance | Yes |
2021-07-01 | Plan benefit arrangement – Insurance | Yes |
2020: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2020 form 5500 responses |
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2020-07-01 | Type of plan entity | Single employer plan |
2020-07-01 | Submission has been amended | No |
2020-07-01 | This submission is the final filing | No |
2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-07-01 | Plan is a collectively bargained plan | No |
2020-07-01 | Plan funding arrangement – Insurance | Yes |
2020-07-01 | Plan benefit arrangement – Insurance | Yes |
2019: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2019 form 5500 responses |
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2019-07-01 | Type of plan entity | Single employer plan |
2019-07-01 | Submission has been amended | No |
2019-07-01 | This submission is the final filing | No |
2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-07-01 | Plan is a collectively bargained plan | No |
2019-07-01 | Plan funding arrangement – Insurance | Yes |
2019-07-01 | Plan benefit arrangement – Insurance | Yes |
2018: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2018 form 5500 responses |
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2018-07-01 | Type of plan entity | Single employer plan |
2018-07-01 | Submission has been amended | No |
2018-07-01 | This submission is the final filing | No |
2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-07-01 | Plan is a collectively bargained plan | No |
2018-07-01 | Plan funding arrangement – Insurance | Yes |
2018-07-01 | Plan benefit arrangement – Insurance | Yes |
2017: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2017 form 5500 responses |
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2017-07-01 | Type of plan entity | Single employer plan |
2017-07-01 | Submission has been amended | No |
2017-07-01 | This submission is the final filing | No |
2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-07-01 | Plan is a collectively bargained plan | No |
2017-07-01 | Plan funding arrangement – Insurance | Yes |
2017-07-01 | Plan benefit arrangement – Insurance | Yes |
2006: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2006 form 5500 responses |
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2006-07-01 | Type of plan entity | Single employer plan |
2006-07-01 | Submission has been amended | No |
2006-07-01 | This submission is the final filing | No |
2006-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2006-07-01 | Plan is a collectively bargained plan | No |
2006-07-01 | Plan funding arrangement – Insurance | Yes |
2006-07-01 | Plan benefit arrangement – Insurance | Yes |
2005: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2005 form 5500 responses |
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2005-07-01 | Type of plan entity | Single employer plan |
2005-07-01 | Submission has been amended | No |
2005-07-01 | This submission is the final filing | No |
2005-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2005-07-01 | Plan is a collectively bargained plan | No |
2005-07-01 | Plan funding arrangement – Insurance | Yes |
2005-07-01 | Plan benefit arrangement – Insurance | Yes |
2004: MIDSTATE ELECTRIC OF OCALA, INC HEALTH & WELFARE 2004 form 5500 responses |
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2004-07-01 | Type of plan entity | Single employer plan |
2004-07-01 | First time form 5500 has been submitted | Yes |
2004-07-01 | Submission has been amended | No |
2004-07-01 | This submission is the final filing | No |
2004-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2004-07-01 | Plan is a collectively bargained plan | No |
2004-07-01 | Plan funding arrangement – Insurance | Yes |
2004-07-01 | Plan benefit arrangement – Insurance | Yes |
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 00629785 |
Policy instance | 3 |
Insurance contract or identification number | 00629785 | Number of Individuals Covered | 70 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $36,206 | Total amount of fees paid to insurance company | USD $30,303 | 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 | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $256,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,206 | Amount paid for insurance broker fees | 30303 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 36586 |
Policy instance | 2 |
Insurance contract or identification number | G015A | Number of Individuals Covered | 3983 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 1 | 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 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $9,644 | Commission paid to Insurance Broker | USD $465 | Insurance broker organization code? | 3 |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 785362 |
Policy instance | 1 |
Insurance contract or identification number | 785362 | Number of Individuals Covered | 56 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $3,468 | Total amount of fees paid to insurance company | USD $203 | 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 | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE & AD&D | 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 $50,143 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,468 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 203 | Additional information about fees paid to insurance broker | BONUSES |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 00629785 |
Policy instance | 4 |
Insurance contract or identification number | 00629785 | Number of Individuals Covered | 78 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $34,948 | Total amount of fees paid to insurance company | USD $7,896 | 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 | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $225,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,948 | Amount paid for insurance broker fees | 7896 | Additional information about fees paid to insurance broker | ADMIN FEES | Insurance broker organization code? | 3 |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 36586 |
Policy instance | 3 |
Insurance contract or identification number | 36586 | Number of Individuals Covered | 104 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $5,098 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | 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 $32,622 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,427 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 16440 |
Policy instance | 2 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 0 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | 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 | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 785362 |
Policy instance | 1 |
Insurance contract or identification number | 785362 | Number of Individuals Covered | 434 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $6,424 | Total amount of fees paid to insurance company | USD $215 | 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 | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE & AD&D | 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 $70,649 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,424 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 215 | Additional information about fees paid to insurance broker | BONUSES |
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AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 36586 |
Policy instance | 3 |
Insurance contract or identification number | 36586 | Number of Individuals Covered | 48 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $22,508 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | 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 $40,273 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,886 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 16440 |
Policy instance | 2 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 78 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $46,633 | 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 | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $46,633 | Insurance broker organization code? | 3 |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 785362 |
Policy instance | 1 |
Insurance contract or identification number | 785362 | Number of Individuals Covered | 220 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $6,942 | 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOL LIFE & AD&D | 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 $66,865 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,804 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | COMMISSION | Insurance broker organization code? | 3 |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 785362 |
Policy instance | 1 |
Insurance contract or identification number | 785362 | Number of Individuals Covered | 255 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $4,640 | Total amount of fees paid to insurance company | USD $455 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $54,803 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 455 | Additional information about fees paid to insurance broker | BONUSES | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
Policy contract number | 16440 |
Policy instance | 2 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 87 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $50,365 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $50,365 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 785362 |
Policy instance | 1 |
Insurance contract or identification number | 785362 | Number of Individuals Covered | 112 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $5,630 | Total amount of fees paid to insurance company | USD $2,000 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE & AD&D | Welfare Benefit Premiums Paid to Carrier | USD $56,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
Policy contract number | 16440 |
Policy instance | 1 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 82 | Insurance policy start date | 2006-07-01 | Insurance policy end date | 2007-06-30 | Total amount of commissions paid to insurance broker | USD $1,012 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $8,048 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,012 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN & BROWN INC DBA |
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FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
Policy contract number | 16440 |
Policy instance | 1 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 164 | Insurance policy start date | 2005-07-01 | Insurance policy end date | 2006-06-30 | Total amount of commissions paid to insurance broker | USD $1,240 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $8,264 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,240 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN & BROWN, INC DBA |
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FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 ) |
Policy contract number | 16440 |
Policy instance | 1 |
Insurance contract or identification number | 16440 | Number of Individuals Covered | 138 | Insurance policy start date | 2004-07-01 | Insurance policy end date | 2005-06-30 | Total amount of commissions paid to insurance broker | USD $697 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD & D | Welfare Benefit Premiums Paid to Carrier | USD $4,648 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $697 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN & BROWN INC DBA |
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