HOUSTON GRAND OPERA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN
Measure | Date | Value |
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2022: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-05-01 | 112 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 128 |
Number of retired or separated participants receiving benefits | 2022-05-01 | 4 |
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 | 132 |
Number of employers contributing to the scheme | 2022-05-01 | 0 |
2021: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-05-01 | 90 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 112 |
Number of retired or separated participants receiving benefits | 2021-05-01 | 2 |
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 | 114 |
Number of employers contributing to the scheme | 2021-05-01 | 0 |
2020: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-05-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 90 |
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 | 90 |
Number of employers contributing to the scheme | 2020-05-01 | 0 |
2019: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-05-01 | 121 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 118 |
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 | 118 |
Number of employers contributing to the scheme | 2019-05-01 | 0 |
2018: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-05-01 | 117 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 121 |
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 | 121 |
Number of employers contributing to the scheme | 2018-05-01 | 0 |
2017: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-05-01 | 106 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 117 |
Number of retired or separated participants receiving benefits | 2017-05-01 | 0 |
Total of all active and inactive participants | 2017-05-01 | 117 |
Total participants | 2017-05-01 | 117 |
2016: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-05-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 113 |
Number of retired or separated participants receiving benefits | 2016-05-01 | 1 |
Total of all active and inactive participants | 2016-05-01 | 114 |
Total participants | 2016-05-01 | 114 |
2015: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-05-01 | 115 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 117 |
Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
Total of all active and inactive participants | 2015-05-01 | 117 |
Total participants | 2015-05-01 | 117 |
2014: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-05-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 109 |
Number of retired or separated participants receiving benefits | 2014-05-01 | 0 |
Total of all active and inactive participants | 2014-05-01 | 109 |
Total participants | 2014-05-01 | 109 |
2013: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-05-01 | 122 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 123 |
Number of retired or separated participants receiving benefits | 2013-05-01 | 1 |
Total of all active and inactive participants | 2013-05-01 | 124 |
Total participants | 2013-05-01 | 124 |
2012: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-05-01 | 120 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 122 |
Number of retired or separated participants receiving benefits | 2012-05-01 | 0 |
Total of all active and inactive participants | 2012-05-01 | 122 |
Total participants | 2012-05-01 | 122 |
2011: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-05-01 | 120 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 120 |
Number of retired or separated participants receiving benefits | 2011-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
Total of all active and inactive participants | 2011-05-01 | 120 |
Total participants | 2011-05-01 | 120 |
2010: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-05-01 | 123 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 117 |
Number of retired or separated participants receiving benefits | 2010-05-01 | 3 |
Total of all active and inactive participants | 2010-05-01 | 120 |
Total participants | 2010-05-01 | 120 |
2009: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-05-01 | 123 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 121 |
Number of retired or separated participants receiving benefits | 2009-05-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 0 |
Total of all active and inactive participants | 2009-05-01 | 123 |
Total participants | 2009-05-01 | 123 |
2022: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
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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: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
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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: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
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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: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
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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: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
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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: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
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2017-05-01 | Type of plan entity | Single employer plan |
2017-05-01 | Submission has been amended | No |
2017-05-01 | This submission is the final filing | No |
2017-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-05-01 | Plan is a collectively bargained plan | No |
2017-05-01 | Plan funding arrangement – Insurance | Yes |
2017-05-01 | Plan benefit arrangement – Insurance | Yes |
2016: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
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2016-05-01 | Type of plan entity | Single employer plan |
2016-05-01 | Submission has been amended | No |
2016-05-01 | This submission is the final filing | No |
2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-05-01 | Plan is a collectively bargained plan | No |
2016-05-01 | Plan funding arrangement – Insurance | Yes |
2016-05-01 | Plan benefit arrangement – Insurance | Yes |
2015: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
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2015-05-01 | Type of plan entity | Single employer plan |
2015-05-01 | Submission has been amended | No |
2015-05-01 | This submission is the final filing | No |
2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-05-01 | Plan is a collectively bargained plan | No |
2015-05-01 | Plan funding arrangement – Insurance | Yes |
2015-05-01 | Plan benefit arrangement – Insurance | Yes |
2014: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
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2014-05-01 | Type of plan entity | Single employer plan |
2014-05-01 | Submission has been amended | No |
2014-05-01 | This submission is the final filing | No |
2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-05-01 | Plan is a collectively bargained plan | No |
2014-05-01 | Plan funding arrangement – Insurance | Yes |
2014-05-01 | Plan benefit arrangement – Insurance | Yes |
2013: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
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2013-05-01 | Type of plan entity | Single employer plan |
2013-05-01 | Submission has been amended | No |
2013-05-01 | This submission is the final filing | No |
2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-05-01 | Plan is a collectively bargained plan | No |
2013-05-01 | Plan funding arrangement – Insurance | Yes |
2013-05-01 | Plan benefit arrangement – Insurance | Yes |
2012: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
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2012-05-01 | Type of plan entity | Single employer plan |
2012-05-01 | Submission has been amended | No |
2012-05-01 | This submission is the final filing | No |
2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-05-01 | Plan is a collectively bargained plan | No |
2012-05-01 | Plan funding arrangement – Insurance | Yes |
2012-05-01 | Plan benefit arrangement – Insurance | Yes |
2011: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
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2011-05-01 | Type of plan entity | Single employer plan |
2011-05-01 | Submission has been amended | No |
2011-05-01 | This submission is the final filing | No |
2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-05-01 | Plan is a collectively bargained plan | No |
2011-05-01 | Plan funding arrangement – Insurance | Yes |
2011-05-01 | Plan benefit arrangement – Insurance | Yes |
2010: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2010 form 5500 responses |
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2010-05-01 | Type of plan entity | Single employer plan |
2010-05-01 | Submission has been amended | No |
2010-05-01 | This submission is the final filing | No |
2010-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-05-01 | Plan is a collectively bargained plan | No |
2010-05-01 | Plan funding arrangement – Insurance | Yes |
2010-05-01 | Plan benefit arrangement – Insurance | Yes |
2009: HOUSTON GRAND OPERA EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
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2009-05-01 | Type of plan entity | Single employer plan |
2009-05-01 | Submission has been amended | No |
2009-05-01 | This submission is the final filing | No |
2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-05-01 | Plan is a collectively bargained plan | No |
2009-05-01 | Plan funding arrangement – Insurance | Yes |
2009-05-01 | Plan benefit arrangement – Insurance | Yes |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BCBS |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BCBS | Number of Individuals Covered | 128 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $9,336 | Total amount of fees paid to insurance company | USD $1,813 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $62,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,336 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 268 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $1,119 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,503 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,119 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 917484 |
Policy instance | 1 |
Insurance contract or identification number | 917484 | Number of Individuals Covered | 204 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $3,280 | Total amount of fees paid to insurance company | USD $58,983 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,287,139 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,280 | Amount paid for insurance broker fees | 57978 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BCBS |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BCBS | Number of Individuals Covered | 112 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $6,911 | Total amount of fees paid to insurance company | USD $2,717 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $46,080 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,911 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 122 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $926 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,852 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $926 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 917484 |
Policy instance | 1 |
Insurance contract or identification number | 917484 | Number of Individuals Covered | 216 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $3,073 | Total amount of fees paid to insurance company | USD $51,198 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,134,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,073 | Amount paid for insurance broker fees | 51198 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 917484 |
Policy instance | 1 |
Insurance contract or identification number | 917484 | Number of Individuals Covered | 191 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $1,903 | Total amount of fees paid to insurance company | USD $52,045 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,147,032 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,903 | Amount paid for insurance broker fees | 52045 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 107 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $843 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,960 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $843 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BCBS |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BCBS | Number of Individuals Covered | 90 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $7,208 | Total amount of fees paid to insurance company | USD $3,297 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $48,053 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,208 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BCBS |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BCBS | Number of Individuals Covered | 118 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $7,742 | Total amount of fees paid to insurance company | USD $2,802 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $51,610 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,742 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 124 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $1,025 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,298 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,024 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 917484 |
Policy instance | 1 |
Insurance contract or identification number | 917484 | Number of Individuals Covered | 156 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $3,043 | Total amount of fees paid to insurance company | USD $66,971 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,468,571 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,043 | Amount paid for insurance broker fees | 66971 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BCBS |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BCBS | Number of Individuals Covered | 121 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $7,259 | Total amount of fees paid to insurance company | USD $1,186 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $48,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,999 | Amount paid for insurance broker fees | 1186 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 123 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $1,085 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,262 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $919 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 415585 |
Policy instance | 1 |
Insurance contract or identification number | 415585 | Number of Individuals Covered | 189 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $69,396 | Total amount of fees paid to insurance company | USD $4,635 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,373,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57,627 | Amount paid for insurance broker fees | 4635 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0876330 |
Policy instance | 3 |
Insurance contract or identification number | 0876330 | Number of Individuals Covered | 119 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $4,262 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21,686 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,262 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | HIGGINBOTHAM INSURANCE AGENCY INC |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001 |
Policy instance | 2 |
Insurance contract or identification number | 10005001 | Number of Individuals Covered | 116 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $804 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $8,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $804 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | HIGGINBOTHAM INSURANCE AGENCY INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 1 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 197 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $69,714 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,293,097 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $69,714 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | HIGGINBOTHAM INSURANCE AGENCY INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0876330 |
Policy instance | 1 |
Insurance contract or identification number | 0876330 | Number of Individuals Covered | 108 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $3,805 | Total amount of fees paid to insurance company | USD $159 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,006 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,805 | Amount paid for insurance broker fees | 159 | Additional information about fees paid to insurance broker | PPP ENGAGEMENT CREDIT | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 2 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 178 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $57,715 | Total amount of fees paid to insurance company | USD $1,579 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,140,156 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57,715 | Amount paid for insurance broker fees | 1579 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | HIGGINBOTHAM INSURANCE AGENCY INC |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10005001001 |
Policy instance | 3 |
Insurance contract or identification number | 10005001001 | Number of Individuals Covered | 91 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,993 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 2 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 153 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $43,932 | Total amount of fees paid to insurance company | USD $1,239 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $912,275 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $43,932 | Amount paid for insurance broker fees | 1239 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0876330 |
Policy instance | 1 |
Insurance contract or identification number | 0876330 | Number of Individuals Covered | 130 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $4,050 | Total amount of fees paid to insurance company | USD $107 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,913 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,050 | Amount paid for insurance broker fees | 107 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0876330 |
Policy instance | 1 |
Insurance contract or identification number | 0876330 | Number of Individuals Covered | 123 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $4,005 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $20,162 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,005 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 2 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 178 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $49,702 | Total amount of fees paid to insurance company | USD $878 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $979,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $49,702 | Amount paid for insurance broker fees | 878 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 1 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 173 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $48,736 | Total amount of fees paid to insurance company | USD $2,685 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $959,425 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,736 | Amount paid for insurance broker fees | 2685 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 876330 |
Policy instance | 2 |
Insurance contract or identification number | 876330 | Number of Individuals Covered | 122 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $3,881 | Total amount of fees paid to insurance company | USD $217 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,422 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,881 | Amount paid for insurance broker fees | 217 | Additional information about fees paid to insurance broker | GI RETENTION SUPPLEMENTAL COMPENSATION LTD INDIRECT COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MADISON BENEFITS GROUP INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 876330 |
Policy instance | 2 |
Insurance contract or identification number | 876330 | Number of Individuals Covered | 120 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $3,525 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,661 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 1 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 185 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $47,993 | Total amount of fees paid to insurance company | USD $1,740 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $944,453 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 174095 |
Policy instance | 2 |
Insurance contract or identification number | 174095 | Number of Individuals Covered | 167 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $45,750 | Total amount of fees paid to insurance company | USD $702 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $898,159 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 876330 |
Policy instance | 1 |
Insurance contract or identification number | 876330 | Number of Individuals Covered | 117 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $3,480 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $17,567 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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