CAPITAL HEALTH PLAN, INC. has sponsored the creation of one or more 401k plans.
Additional information about CAPITAL HEALTH PLAN, INC.
Submission information for form 5500 for 401k plan CAPITAL HEALTH PLAN BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: CAPITAL HEALTH PLAN BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 445 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 439 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Total of all active and inactive participants | 2022-01-01 | 440 |
| Total participants | 2022-01-01 | 440 |
| Number of participants with account balances | 2022-01-01 | 0 |
| 2021: CAPITAL HEALTH PLAN BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 449 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 442 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 3 |
| Total of all active and inactive participants | 2021-01-01 | 445 |
| Total participants | 2021-01-01 | 445 |
| Number of participants with account balances | 2021-01-01 | 0 |
| 2020: CAPITAL HEALTH PLAN BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 436 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 447 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 2 |
| Total of all active and inactive participants | 2020-01-01 | 449 |
| Total participants | 2020-01-01 | 449 |
| Number of participants with account balances | 2020-01-01 | 0 |
| 2019: CAPITAL HEALTH PLAN BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 426 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 432 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 4 |
| Total of all active and inactive participants | 2019-01-01 | 436 |
| Total participants | 2019-01-01 | 436 |
| Number of participants with account balances | 2019-01-01 | 0 |
| 2018: CAPITAL HEALTH PLAN BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 421 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 5 |
| Total of all active and inactive participants | 2018-01-01 | 426 |
| Total participants | 2018-01-01 | 426 |
| 2017: CAPITAL HEALTH PLAN BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 421 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 422 |
| Total participants | 2017-01-01 | 422 |
| 2016: CAPITAL HEALTH PLAN BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 417 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 3 |
| Total of all active and inactive participants | 2016-01-01 | 420 |
| Total participants | 2016-01-01 | 420 |
| 2015: CAPITAL HEALTH PLAN BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 412 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 8 |
| Total of all active and inactive participants | 2015-01-01 | 420 |
| Total participants | 2015-01-01 | 420 |
| 2014: CAPITAL HEALTH PLAN BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 421 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 414 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 5 |
| Total of all active and inactive participants | 2014-01-01 | 419 |
| Total participants | 2014-01-01 | 419 |
| 2013: CAPITAL HEALTH PLAN BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 423 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 421 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 3 |
| Total of all active and inactive participants | 2013-01-01 | 424 |
| Total participants | 2013-01-01 | 424 |
| 2012: CAPITAL HEALTH PLAN BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 423 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 416 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 7 |
| Total of all active and inactive participants | 2012-01-01 | 423 |
| Total participants | 2012-01-01 | 423 |
| 2011: CAPITAL HEALTH PLAN BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 412 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 416 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 7 |
| Total of all active and inactive participants | 2011-01-01 | 423 |
| Total participants | 2011-01-01 | 423 |
| 2009: CAPITAL HEALTH PLAN BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 417 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 1 |
| Total of all active and inactive participants | 2009-01-01 | 418 |
| Total participants | 2009-01-01 | 418 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010236488 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010236488 | | Number of Individuals Covered | 391 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $25,787 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $386,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,293 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 790712 |
| Policy instance | 3 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,700 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,681 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,700 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 790712 |
| Policy instance | 2 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $886 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $886 | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 440 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $8,488,582 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010236488 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010236488 | | Number of Individuals Covered | 444 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $48,159 | | Total amount of fees paid to insurance company | USD $16,159 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $425,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,238 | | Amount paid for insurance broker fees | 16159 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 445 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $8,389,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 790712 |
| Policy instance | 2 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,096 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $800 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 790712 |
| Policy instance | 3 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $15,623 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $171,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,379 | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 449 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $7,991,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 790712 |
| Policy instance | 2 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,134 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,134 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 790712 |
| Policy instance | 3 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $14,790 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,799 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010236488 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010236488 | | Number of Individuals Covered | 452 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $41,449 | | Total amount of fees paid to insurance company | USD $15,134 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $365,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,449 | | Amount paid for insurance broker fees | 15134 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010236488 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010236488 | | Number of Individuals Covered | 443 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $35,109 | | Total amount of fees paid to insurance company | USD $34,511 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 34511 | | Additional information about fees paid to insurance broker | OVERRIDES/BROKER BONUS | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $25,633 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 790712 |
| Policy instance | 3 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $14,020 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $140,830 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,182 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 790712 |
| Policy instance | 2 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,956 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,586 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,303 | | Insurance broker organization code? | 3 |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $7,629,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $7,229,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $2,501 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,501 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 790712 |
| Policy instance | 3 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,341 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,187 | | Insurance broker organization code? | 3 |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 790712 |
| Policy instance | 5 |
| Insurance contract or identification number | 790712 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,544 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,301 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 598494 |
| Policy instance | 4 |
| Insurance contract or identification number | 598494 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $893 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,711 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $893 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010236488 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010236488 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $30,077 | | Total amount of fees paid to insurance company | USD $13,291 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,077 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13291 | | Additional information about fees paid to insurance broker | OVERRIDES |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 598494 |
| Policy instance | 4 |
| Insurance contract or identification number | 598494 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,724 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,724 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 3 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $10,338 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,338 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 435 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $29,303 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $293,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,303 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $6,546,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 419 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $29,397 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $293,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,397 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 3 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $9,381 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,381 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 598494 |
| Policy instance | 4 |
| Insurance contract or identification number | 598494 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,646 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,307 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,646 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $5,433,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 419 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $5,411,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 421 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $30,243 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $302,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,243 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 3 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,617 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,617 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 598494 |
| Policy instance | 4 |
| Insurance contract or identification number | 598494 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,732 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,732 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 3 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,794 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,794 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 1 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 424 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $5,208,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 425 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $32,631 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $326,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,631 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC. |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 1 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,617 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,617 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 418 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $26,831 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $268,307 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,831 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC. |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 3 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,924,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 3 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,730,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 2 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $29,446 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $294,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614, CD3107 |
| Policy instance | 1 |
| Insurance contract or identification number | 5614, CD3107 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,013 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPBENEFITS COMPANY (National Association of Insurance Commissioners NAIC id number: 52015 ) |
| Policy contract number | 5614 |
| Policy instance | 2 |
| Insurance contract or identification number | 5614 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,919 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,919 | | Insurance broker organization code? | 3 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 316748 |
| Policy instance | 1 |
| Insurance contract or identification number | 316748 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $28,564 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $285,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,564 | | Insurance broker name | WINCHESTER FINANCIAL GROUP, INC. |
|
| CAPITAL HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95112 ) |
| Policy contract number | 00001 |
| Policy instance | 3 |
| Insurance contract or identification number | 00001 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,373,547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
