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AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan NameAMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN
Plan identification number 501

AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

AMPAM PARKS MECHANICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:AMPAM PARKS MECHANICAL, INC.
Employer identification number (EIN):742930667
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-09-01ERIC FRID2023-01-26
5012020-09-01ERIC FRID
5012019-09-01JAMES C WRIGHT2021-03-11
5012018-09-01JAMES C WRIGHT2020-03-02
5012017-09-01JAMES C WRIGHT2019-04-22
5012016-09-01
5012015-09-01
5012014-09-01
5012013-09-01
5012012-09-01JAMES C WRIGHT
5012011-09-01JAMES C WRIGHT
5012009-09-01JAMES C WRIGHT
5012007-09-01JAMES WRIGHT
5012006-09-01JAMES WRIGHT
5012005-09-01JAMES WRIGHT

Plan Statistics for AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN

Measure Date Value
2021: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01225
Total number of active participants reported on line 7a of the Form 55002021-09-01225
Total of all active and inactive participants2021-09-01225
2020: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01266
Total number of active participants reported on line 7a of the Form 55002020-09-01225
Total of all active and inactive participants2020-09-01225
2019: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01186
Total number of active participants reported on line 7a of the Form 55002019-09-01266
Total of all active and inactive participants2019-09-01266
2018: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01161
Total number of active participants reported on line 7a of the Form 55002018-09-01186
Total of all active and inactive participants2018-09-01186
2017: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01152
Total number of active participants reported on line 7a of the Form 55002017-09-01161
Total of all active and inactive participants2017-09-01161
2016: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01127
Total number of active participants reported on line 7a of the Form 55002016-09-01152
Total of all active and inactive participants2016-09-01152
2015: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01142
Total number of active participants reported on line 7a of the Form 55002015-09-01127
Total of all active and inactive participants2015-09-01127
2014: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01147
Total number of active participants reported on line 7a of the Form 55002014-09-01142
Total of all active and inactive participants2014-09-01142
2013: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01121
Total number of active participants reported on line 7a of the Form 55002013-09-01147
Total of all active and inactive participants2013-09-01147
2012: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01102
Total number of active participants reported on line 7a of the Form 55002012-09-01121
Total of all active and inactive participants2012-09-01121
2011: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01132
Total number of active participants reported on line 7a of the Form 55002011-09-01102
Total of all active and inactive participants2011-09-01102
2009: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01216
Total number of active participants reported on line 7a of the Form 55002009-09-01174
Total of all active and inactive participants2009-09-01174
2007: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-09-01237
Total number of active participants reported on line 7a of the Form 55002007-09-01216
Total of all active and inactive participants2007-09-01216
Total participants2007-09-01216
2006: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year2006-09-01221
Total number of active participants reported on line 7a of the Form 55002006-09-01237
Total of all active and inactive participants2006-09-01237
Total participants2006-09-01237
2005: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2005 401k membership
Total participants, beginning-of-year2005-09-010
Total number of active participants reported on line 7a of the Form 55002005-09-01221
Total of all active and inactive participants2005-09-01221
Total participants2005-09-01221

Form 5500 Responses for AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN

2021: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – General assets of the sponsorYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – General assets of the sponsorYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – General assets of the sponsorYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – General assets of the sponsorYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – General assets of the sponsorYes
2011-09-01Plan benefit arrangement – InsuranceYes
2009: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01This submission is the final filingNo
2009-09-01Plan funding arrangement – General assets of the sponsorYes
2009-09-01Plan benefit arrangement – InsuranceYes
2007: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2007 form 5500 responses
2007-09-01Type of plan entitySingle employer plan
2007-09-01Submission has been amendedNo
2007-09-01This submission is the final filingNo
2007-09-01This return/report is a short plan year return/report (less than 12 months)No
2007-09-01Plan is a collectively bargained planNo
2007-09-01Plan funding arrangement – General assets of the sponsorYes
2007-09-01Plan benefit arrangement – InsuranceYes
2006: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2006 form 5500 responses
2006-09-01Type of plan entitySingle employer plan
2006-09-01Submission has been amendedNo
2006-09-01This submission is the final filingNo
2006-09-01This return/report is a short plan year return/report (less than 12 months)No
2006-09-01Plan is a collectively bargained planNo
2006-09-01Plan funding arrangement – General assets of the sponsorYes
2006-09-01Plan benefit arrangement – InsuranceYes
2005: AMPAM PARKS MECHANICAL, INC. HEALTH & WELFARE PLAN 2005 form 5500 responses
2005-09-01Type of plan entitySingle employer plan
2005-09-01First time form 5500 has been submittedYes
2005-09-01Submission has been amendedNo
2005-09-01This submission is the final filingNo
2005-09-01This return/report is a short plan year return/report (less than 12 months)No
2005-09-01Plan is a collectively bargained planNo
2005-09-01Plan funding arrangement – General assets of the sponsorYes
2005-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0175211HNO
Policy instance 2
Insurance contract or identification number0175211HNO
Number of Individuals Covered218
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $69,535
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,173,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,714
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618134
Policy instance 1
Insurance contract or identification number618134
Number of Individuals Covered935
Insurance policy start date2022-09-01
Insurance policy end date2023-09-01
Total amount of commissions paid to insurance brokerUSD $3,055
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $84,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,055
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0175211
Policy instance 3
Insurance contract or identification number0175211
Number of Individuals Covered41
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $27,934
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $466,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,185
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number914304
Policy instance 1
Insurance contract or identification number914304
Number of Individuals Covered148
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $14,107
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,107
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618134
Policy instance 2
Insurance contract or identification number618134
Number of Individuals Covered968
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $5,348
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $86,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,348
Insurance broker organization code?3
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number662203
Policy instance 3
Insurance contract or identification number662203
Number of Individuals Covered131
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $2,475
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,980
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number476591
Policy instance 4
Insurance contract or identification number476591
Number of Individuals Covered85
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $4,936
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $9,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,527
Insurance broker organization code?4
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number476592
Policy instance 5
Insurance contract or identification number476592
Number of Individuals Covered55
Insurance policy start date2021-09-01
Insurance policy end date2022-09-01
Total amount of commissions paid to insurance brokerUSD $3,123
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedATTAINED AGE CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $13,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,301
Insurance broker organization code?4
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0175211HNO
Policy instance 6
Insurance contract or identification number0175211HNO
Number of Individuals Covered200
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $51,959
Total amount of fees paid to insurance companyUSD $7,500
Welfare Benefit Premiums Paid to CarrierUSD $946,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,126
Amount paid for insurance broker fees7500
Additional information about fees paid to insurance brokerNEW BUSINESS INCENTIVE RISK
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0175211
Policy instance 7
Insurance contract or identification number0175211
Number of Individuals Covered43
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $22,575
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $412,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,737
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0065008
Policy instance 1
Insurance contract or identification numberW0065008
Number of Individuals Covered225
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $103,364
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,371,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees74466
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number914304
Policy instance 2
Insurance contract or identification number914304
Number of Individuals Covered106
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $11,242
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,242
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618134
Policy instance 3
Insurance contract or identification number618134
Number of Individuals Covered1041
Insurance policy start date2020-09-01
Insurance policy end date2021-09-01
Total amount of commissions paid to insurance brokerUSD $1,346
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $90,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,346
Insurance broker organization code?3
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number662203
Policy instance 4
Insurance contract or identification number662203
Number of Individuals Covered121
Insurance policy start date2020-09-01
Insurance policy end date2021-09-01
Total amount of commissions paid to insurance brokerUSD $3,014
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,411
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618134
Policy instance 3
Insurance contract or identification number618134
Number of Individuals Covered1028
Insurance policy start date2019-09-01
Insurance policy end date2020-09-01
Total amount of commissions paid to insurance brokerUSD $3,803
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $93,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,803
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0065008
Policy instance 1
Insurance contract or identification numberW0065008
Number of Individuals Covered266
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $110,436
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,502,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees79076
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number914304
Policy instance 2
Insurance contract or identification number914304
Number of Individuals Covered164
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $17,718
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,718
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618134
Policy instance 3
Insurance contract or identification number618134
Number of Individuals Covered1059
Insurance policy start date2018-09-01
Insurance policy end date2019-09-01
Total amount of commissions paid to insurance brokerUSD $3,902
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $101,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,902
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number914304
Policy instance 2
Insurance contract or identification number914304
Number of Individuals Covered166
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $17,936
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $179,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,936
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0065008
Policy instance 1
Insurance contract or identification numberW0065008
Number of Individuals Covered276
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $100,485
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,435,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,775
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered150
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $15,359
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered63
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,571
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0065008
Policy instance 3
Insurance contract or identification numberW0065008
Number of Individuals Covered253
Insurance policy start date2017-09-01
Insurance policy end date2017-08-31
Total amount of commissions paid to insurance brokerUSD $87,210
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,245,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered127
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $13,277
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,277
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered91
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $2,099
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,099
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0805114
Policy instance 3
Insurance contract or identification number0805114
Number of Individuals Covered36
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $8,876
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $192,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,876
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered120
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $12,936
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,936
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered93
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $2,305
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,305
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number278749
Policy instance 3
Insurance contract or identification number278749
Number of Individuals Covered203
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $44,842
Total amount of fees paid to insurance companyUSD $4,225
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $972,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,636
Amount paid for insurance broker fees4225
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, TRAINING
Insurance broker organization code?3
Insurance broker nameALBERT C. SIMONDS & CO
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number69551A
Policy instance 3
Insurance contract or identification number69551A
Number of Individuals Covered147
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $39,752
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $882,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,752
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered103
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $1,753
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,753
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered111
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $9,944
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,944
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number69551A
Policy instance 3
Insurance contract or identification number69551A
Number of Individuals Covered121
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $36,947
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $756,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,947
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered70
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $7,100
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,100
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered59
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $1,284
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,284
Insurance broker organization code?3
Insurance broker nameJOHN MICHAEL MOODY
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered44
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $1,013
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered64
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $5,583
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number69551A
Policy instance 3
Insurance contract or identification number69551A
Number of Individuals Covered102
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $25,049
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $482,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5298401
Policy instance 1
Insurance contract or identification number5298401
Number of Individuals Covered24
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $600
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5298401
Policy instance 2
Insurance contract or identification number5298401
Number of Individuals Covered43
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $3,638
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUS392856
Policy instance 3
Insurance contract or identification numberUS392856
Number of Individuals Covered132
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $16,513
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $330,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number804856
Policy instance 4
Insurance contract or identification number804856
Number of Individuals Covered67
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $6,395
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $120,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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