GEORGETOWN COLLEGE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GEORGETOWN COLLEGE HEALTHCARE PLAN
| Measure | Date | Value |
|---|
| 2019: GEORGETOWN COLLEGE HEALTHCARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 280 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 276 |
| Total of all active and inactive participants | 2019-01-01 | 276 |
| Total participants | 2019-01-01 | 0 |
| 2018: GEORGETOWN COLLEGE HEALTHCARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 280 |
| Total of all active and inactive participants | 2018-01-01 | 280 |
| 2017: GEORGETOWN COLLEGE HEALTHCARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 159 |
| Total of all active and inactive participants | 2017-01-01 | 159 |
| 2016: GEORGETOWN COLLEGE HEALTHCARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 158 |
| Total of all active and inactive participants | 2016-01-01 | 158 |
| 2015: GEORGETOWN COLLEGE HEALTHCARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 160 |
| Total of all active and inactive participants | 2015-01-01 | 160 |
| 2014: GEORGETOWN COLLEGE HEALTHCARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 188 |
| Total of all active and inactive participants | 2014-01-01 | 188 |
| 2013: GEORGETOWN COLLEGE HEALTHCARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 384 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 212 |
| Total of all active and inactive participants | 2013-01-01 | 212 |
| 2012: GEORGETOWN COLLEGE HEALTHCARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 378 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 384 |
| Total of all active and inactive participants | 2012-01-01 | 384 |
| 2011: GEORGETOWN COLLEGE HEALTHCARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 379 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 378 |
| Total of all active and inactive participants | 2011-01-01 | 378 |
| 2010: GEORGETOWN COLLEGE HEALTHCARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 379 |
| Total of all active and inactive participants | 2010-01-01 | 379 |
| 2009: GEORGETOWN COLLEGE HEALTHCARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 232 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 10 |
| Total of all active and inactive participants | 2009-01-01 | 242 |
| 2019: GEORGETOWN COLLEGE HEALTHCARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GEORGETOWN COLLEGE HEALTHCARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GEORGETOWN COLLEGE HEALTHCARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GEORGETOWN COLLEGE HEALTHCARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GEORGETOWN COLLEGE HEALTHCARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GEORGETOWN COLLEGE HEALTHCARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GEORGETOWN COLLEGE HEALTHCARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GEORGETOWN COLLEGE HEALTHCARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GEORGETOWN COLLEGE HEALTHCARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: GEORGETOWN COLLEGE HEALTHCARE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GEORGETOWN COLLEGE HEALTHCARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI960903 |
| Policy instance | 3 |
| Insurance contract or identification number | AI960903 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $667 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $4,444 | | 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 | 912698 |
| Policy instance | 1 |
| Insurance contract or identification number | 912698 | | Number of Individuals Covered | 276 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,421 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $931,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,421 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | AI960903 |
| Policy instance | 2 |
| Insurance contract or identification number | AI960903 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $667 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $4,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $667 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI960870 |
| Policy instance | 3 |
| Insurance contract or identification number | CI960870 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,033 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $6,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,033 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 64548 ) |
| Policy contract number | CI960870 |
| Policy instance | 2 |
| Insurance contract or identification number | CI960870 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,033 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $6,888 | | 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 | 912698 |
| Policy instance | 1 |
| Insurance contract or identification number | 912698 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,923 | | Total amount of fees paid to insurance company | USD $492 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,145,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,844 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 280 | | Additional information about fees paid to insurance broker | BONUS |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | H00611 |
| Policy instance | 2 |
| Insurance contract or identification number | H00611 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $735 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL ACCIDENT & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $3,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $735 | | Insurance broker organization code? | 3 |
|
| CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 ) |
| Policy contract number | H00611 |
| Policy instance | 3 |
| Insurance contract or identification number | H00611 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,016 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL ACCIDENT & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $4,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,016 | | Insurance broker organization code? | 3 |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 634162 |
| Policy instance | 3 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,532 | | Total amount of fees paid to insurance company | USD $799 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,532 | | Amount paid for insurance broker fees | 799 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | H00611 |
| Policy instance | 2 |
| Insurance contract or identification number | H00611 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,077 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP VOLUNTARY & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $4,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,077 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
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| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 634162 |
| Policy instance | 1 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $22,581 | | Total amount of fees paid to insurance company | USD $7,271 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,172,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,581 | | Amount paid for insurance broker fees | 7271 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
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| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 634162 |
| Policy instance | 1 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $46,794 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,179,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,794 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
|
| COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 ) |
| Policy contract number | 634162 |
| Policy instance | 3 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,136 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,085 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,136 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | 850895 |
| Policy instance | 2 |
| Insurance contract or identification number | 850895 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,015 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | GROUP VOLUNTARY & CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $5,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,517 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC. |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 634162 |
| Policy instance | 1 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $58,546 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,328,557 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,546 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3479680 |
| Policy instance | 1 |
| Insurance contract or identification number | E3479680 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,030 | | Total amount of fees paid to insurance company | USD $67 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | VOLUNTARY CANCER AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $6,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $296 | | Amount paid for insurance broker fees | 24 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ANTHONY STEWART LEE, II |
|
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
| Policy contract number | 634162 |
| Policy instance | 2 |
| Insurance contract or identification number | 634162 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $63,005 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,411,327 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,010 | | Insurance broker organization code? | 3 | | Insurance broker name | BB&T INSURANCE SERVICE, INC |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3479680 |
| Policy instance | 2 |
| Insurance contract or identification number | E3479680 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,406 | | Total amount of fees paid to insurance company | USD $570 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | VOLUNTARY CANCER AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,569 | | Amount paid for insurance broker fees | 223 | | Insurance broker organization code? | 3 | | Insurance broker name | BARBARA PAYNE |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 001003731 |
| Policy instance | 1 |
| Insurance contract or identification number | 001003731 | | Number of Individuals Covered | 384 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $59,988 | | Total amount of fees paid to insurance company | USD $74 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,598,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,774 | | Amount paid for insurance broker fees | 74 | | Insurance broker organization code? | 3 | | Insurance broker name | B B & T INSURANCE SERVICES INC |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 001003731 |
| Policy instance | 1 |
| Insurance contract or identification number | 001003731 | | Number of Individuals Covered | 378 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $33,825 | | Total amount of fees paid to insurance company | USD $6,370 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,592,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3479680 |
| Policy instance | 2 |
| Insurance contract or identification number | E3479680 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,541 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | VOLUNTARY CANCER AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 001003731 |
| Policy instance | 1 |
| Insurance contract or identification number | 001003731 | | Number of Individuals Covered | 379 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $57,340 | | Total amount of fees paid to insurance company | USD $5,820 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,461,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,340 | | Amount paid for insurance broker fees | 5820 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING | | Insurance broker organization code? | 3 | | Insurance broker name | NEACE LUKENS INC |
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