WASHITA VALLEY ENTERPRISES INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN
401k plan membership statisitcs for WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN
| Measure | Date | Value |
|---|
| 2022: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 362 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 310 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 310 |
| Number of employers contributing to the scheme | 2022-05-01 | 0 |
| 2021: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 318 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 362 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 362 |
| 2020: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 400 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 318 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 318 |
| 2019: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 477 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 400 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 400 |
| 2018: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 477 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 477 |
| 2017: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 361 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 420 |
| Number of retired or separated participants receiving benefits | 2017-05-01 | 0 |
| Total of all active and inactive participants | 2017-05-01 | 420 |
| 2016: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 508 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 358 |
| Number of retired or separated participants receiving benefits | 2016-05-01 | 3 |
| Total of all active and inactive participants | 2016-05-01 | 361 |
| 2015: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 508 |
| Total of all active and inactive participants | 2015-05-01 | 508 |
| 2014: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-05-01 | 400 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 540 |
| Number of retired or separated participants receiving benefits | 2014-05-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 54 |
| Total of all active and inactive participants | 2014-05-01 | 597 |
| 2013: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-05-01 | 380 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 400 |
| Total of all active and inactive participants | 2013-05-01 | 400 |
| 2012: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-05-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 380 |
| Total of all active and inactive participants | 2012-05-01 | 380 |
| 2011: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 363 |
| Total of all active and inactive participants | 2011-05-01 | 363 |
| 2009: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 191 |
| Total of all active and inactive participants | 2009-05-01 | 191 |
| 2022: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2022 form 5500 responses |
|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2014 form 5500 responses |
|---|
| 2014-05-01 | Type of plan entity | Single employer plan |
| 2014-05-01 | Plan funding arrangement – Insurance | Yes |
| 2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2013 form 5500 responses |
|---|
| 2013-05-01 | Type of plan entity | Single employer plan |
| 2013-05-01 | Plan funding arrangement – Insurance | Yes |
| 2013-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2012 form 5500 responses |
|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: WASHITA VALLEY ENTERPRISES INC HEALTH & LIFE PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 3 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $2,148 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,999 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 2 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $85,288 | | Total amount of fees paid to insurance company | USD $6,136 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,976,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $78,439 | | Amount paid for insurance broker fees | 6136 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS, NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 952784 |
| Policy instance | 1 |
| Insurance contract or identification number | 952784 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $13,100 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $86,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,100 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 1 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 362 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $67,990 | | Total amount of fees paid to insurance company | USD $1,830 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,656,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,990 | | Amount paid for insurance broker fees | 1830 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 2 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $8,014 | | Total amount of fees paid to insurance company | USD $2,173 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,014 | | Amount paid for insurance broker fees | 2173 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 952784 |
| Policy instance | 3 |
| Insurance contract or identification number | 952784 | | Number of Individuals Covered | 303 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 $1,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 2 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $10,623 | | Total amount of fees paid to insurance company | USD $1,846 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $28,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,623 | | Amount paid for insurance broker fees | 1846 | | Additional information about fees paid to insurance broker | INCENTIVE PLAN PAYMENTS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 1 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 318 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $52,476 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,340,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,476 | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 2 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 314 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $9,478 | | Total amount of fees paid to insurance company | USD $4,609 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $31,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,478 | | Amount paid for insurance broker fees | 4609 | | Additional information about fees paid to insurance broker | INCENTIVE PLAN PAYMENTS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 1 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $73,460 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,846,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73,460 | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 2 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 477 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $64,522 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,647,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,522 | | Insurance broker organization code? | 3 |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 1 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $1,809 | | Total amount of fees paid to insurance company | USD $423 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $16,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,809 | | Amount paid for insurance broker fees | 423 | | Additional information about fees paid to insurance broker | INCENTIVE PLAN PAYMENTS | | Insurance broker organization code? | 3 |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 195233 |
| Policy instance | 2 |
| Insurance contract or identification number | 195233 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $57,843 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,456,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,843 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F020517 |
| Policy instance | 1 |
| Insurance contract or identification number | F020517 | | Number of Individuals Covered | 314 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $1,536 | | Total amount of fees paid to insurance company | USD $212 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $12,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,536 | | Amount paid for insurance broker fees | 212 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $57,190 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $382,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,190 | | Insurance broker organization code? | 3 | | Insurance broker name | CAPITOL BENEFITS GROUP, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0729641 |
| Policy instance | 2 |
| Insurance contract or identification number | 0729641 | | Number of Individuals Covered | 508 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $2,565 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,565 | | Insurance broker organization code? | 3 | | Insurance broker name | CAPITOL BENEFITS GROUP, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0729641 |
| Policy instance | 2 |
| Insurance contract or identification number | 0729641 | | Number of Individuals Covered | 530 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $2,568 | | 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 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,267 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,568 | | Insurance broker organization code? | 3 | | Insurance broker name | CAPITAL BENEFITS GROUP, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 417 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $64,858 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $437,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,858 | | Insurance broker organization code? | 3 | | Insurance broker name | CAPITAL BENEFITS GROUP, INC. |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $2,030 | | Total amount of fees paid to insurance company | USD $74,827 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,812,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,416 | | Amount paid for insurance broker fees | 74827 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 380 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $92,539 | | Total amount of fees paid to insurance company | USD $208 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,829,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $92,539 | | Amount paid for insurance broker fees | 208 | | Additional information about fees paid to insurance broker | BONUS N/A | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $75,434 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,490,266 | | 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 | 729641 |
| Policy instance | 1 |
| Insurance contract or identification number | 729641 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $47,800 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $943,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,800 | | Insurance broker organization code? | 3 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
|
