COMMUNITYCARE HMO, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN
401k plan membership statisitcs for COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2023: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 462 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 473 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 5 |
| Total of all active and inactive participants | 2023-01-01 | 482 |
| Total participants | 2023-01-01 | 0 |
| 2022: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 436 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 451 |
| Total of all active and inactive participants | 2022-01-01 | 451 |
| Total participants | 2022-01-01 | 0 |
| 2021: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 401 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 431 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 5 |
| Total of all active and inactive participants | 2021-01-01 | 436 |
| Total participants | 2021-01-01 | 0 |
| 2020: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 422 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 7 |
| Total participants | 2020-01-01 | 7 |
| 2019: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 434 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 406 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 11 |
| Total of all active and inactive participants | 2019-01-01 | 427 |
| Total participants | 2019-01-01 | 427 |
| 2018: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 471 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 414 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 2 |
| Total of all active and inactive participants | 2018-01-01 | 424 |
| Total participants | 2018-01-01 | 424 |
| 2017: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 458 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 465 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 471 |
| Total participants | 2017-01-01 | 471 |
| 2016: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 457 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 458 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 2 |
| Total of all active and inactive participants | 2016-01-01 | 464 |
| Total participants | 2016-01-01 | 464 |
| 2015: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 464 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 456 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 457 |
| Total participants | 2015-01-01 | 457 |
| 2014: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 465 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 461 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 3 |
| Total of all active and inactive participants | 2014-01-01 | 464 |
| Total participants | 2014-01-01 | 464 |
| 2013: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 430 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 454 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 1 |
| Total of all active and inactive participants | 2013-01-01 | 455 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 455 |
| Number of participants with account balances | 2013-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 433 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 427 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 3 |
| Total of all active and inactive participants | 2012-01-01 | 430 |
| Total participants | 2012-01-01 | 430 |
| 2011: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 439 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 428 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 3 |
| Total of all active and inactive participants | 2011-01-01 | 431 |
| Total participants | 2011-01-01 | 431 |
| 2009: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 462 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 458 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 2 |
| Total of all active and inactive participants | 2009-01-01 | 460 |
| Total participants | 2009-01-01 | 460 |
| 2023: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: COMMUNITYCARE HMO, INC. GROUP HEALTH 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 funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: COMMUNITYCARE HMO, INC. GROUP HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $17,659 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 472 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,318,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 453 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,526 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,526 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,805,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $16,280 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,280 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 433 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,928,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 403 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,501,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,492 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,480 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30093932 |
| Policy instance | 3 |
| Insurance contract or identification number | 30093932 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,698 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $174 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 409 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $14,782 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,782 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 405 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,614,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 432 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $16,599 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,599 | | Insurance broker organization code? | 3 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 424 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,561,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 469 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $15,605 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,605 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 462 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,242,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,716,371 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $15,489 | | Dental 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 | 15489 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 452 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,914,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $37,963 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,963 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 446 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,891,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 454 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,181 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,181 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 430 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $12,980 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,980 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,235,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 416 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $4,027,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 2 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 431 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $11,824 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMMUNITYCARE (National Association of Insurance Commissioners NAIC id number: 89008 ) |
| Policy contract number | C08078 |
| Policy instance | 1 |
| Insurance contract or identification number | C08078 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $73,298 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 2 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 413 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | HIGH DEDUCTIBLE | | Welfare Benefit Premiums Paid to Carrier | USD $3,404,209 |
|
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) |
| Policy contract number | C08078 |
| Policy instance | 3 |
| Insurance contract or identification number | C08078 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | POINT OF SERVICE | | Welfare Benefit Premiums Paid to Carrier | USD $141,936 |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
| Policy contract number | 2075 |
| Policy instance | 4 |
| Insurance contract or identification number | 2075 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $10,833 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $10,833 | | Insurance broker organization code? | 3 | | Insurance broker name | JIM RULEY & CO INC |
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