THE COMPANY OF ROCK HOUSE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE COMPANY OF ROCK HOUSE HEALTH INSURANCE
| Measure | Date | Value |
|---|
| 2022: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 112 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 112 |
| 2021: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 129 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 129 |
| 2020: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 138 |
| Number of retired or separated participants receiving benefits | 2020-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
| Total of all active and inactive participants | 2020-03-01 | 138 |
| 2019: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 128 |
| Number of retired or separated participants receiving benefits | 2019-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-03-01 | 0 |
| Total of all active and inactive participants | 2019-03-01 | 128 |
| 2018: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 138 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
| Total of all active and inactive participants | 2018-03-01 | 138 |
| 2017: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 138 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
| Total of all active and inactive participants | 2017-03-01 | 138 |
| 2016: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 143 |
| Number of retired or separated participants receiving benefits | 2016-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
| Total of all active and inactive participants | 2016-03-01 | 143 |
| 2015: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 160 |
| Number of retired or separated participants receiving benefits | 2015-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
| Total of all active and inactive participants | 2015-03-01 | 160 |
| 2014: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 166 |
| Number of retired or separated participants receiving benefits | 2014-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-03-01 | 0 |
| Total of all active and inactive participants | 2014-03-01 | 166 |
| 2013: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 135 |
| Number of retired or separated participants receiving benefits | 2013-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-03-01 | 0 |
| Total of all active and inactive participants | 2013-03-01 | 135 |
| 2012: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 122 |
| Number of retired or separated participants receiving benefits | 2012-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-03-01 | 0 |
| Total of all active and inactive participants | 2012-03-01 | 122 |
| 2011: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 138 |
| Number of retired or separated participants receiving benefits | 2011-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-03-01 | 0 |
| Total of all active and inactive participants | 2011-03-01 | 138 |
| 2022: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2022 form 5500 responses |
|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2021 form 5500 responses |
|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2020 form 5500 responses |
|---|
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2019 form 5500 responses |
|---|
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: THE COMPANY OF ROCK HOUSE HEALTH INSURANCE 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $791 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $424 | | Additional information about fees paid to insurance broker | BROKER ORGAN TRANSPLANT | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5735670 |
| Policy instance | 1 |
| Insurance contract or identification number | 5735670 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $26,397 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (SPECIFY) - ADD | | Welfare Benefit Premiums Paid to Carrier | USD $207,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,649 | | Additional information about fees paid to insurance broker | BROKER COMMISSION DENTAL COVERAGE | | Insurance broker organization code? | 3 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI50916 |
| Policy instance | 3 |
| Insurance contract or identification number | CLI50916 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $38,813 | | Total amount of fees paid to insurance company | USD $54,047 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,741 | | Amount paid for insurance broker fees | 51205 | | Additional information about fees paid to insurance broker | ADMINISTRATOR HEALTH PLAN | | Insurance broker organization code? | 5 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI50916 |
| Policy instance | 3 |
| Insurance contract or identification number | CLI50916 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $86,134 | | Total amount of fees paid to insurance company | USD $8,390 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $229,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,024 | | Amount paid for insurance broker fees | 5212 | | Additional information about fees paid to insurance broker | ADMINISTRATOR HEALTH PLAN | | Insurance broker organization code? | 5 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $1,484 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,039 | | Additional information about fees paid to insurance broker | ADMINISTRATOR ORGAN TRANSPLANT | | Insurance broker organization code? | 5 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5735670 |
| Policy instance | 1 |
| Insurance contract or identification number | 5735670 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $22,726 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (SPECIFY) - ADD | | Welfare Benefit Premiums Paid to Carrier | USD $196,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,051 | | Additional information about fees paid to insurance broker | BROKER COMMISSION DENTAL COVERAGE | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5735670 |
| Policy instance | 1 |
| Insurance contract or identification number | 5735670 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $23,253 | | Total amount of fees paid to insurance company | USD $1,674 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | OTHER (SPECIFY) - ADD | | Welfare Benefit Premiums Paid to Carrier | USD $192,450 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,127 | | Amount paid for insurance broker fees | 1674 | | Additional information about fees paid to insurance broker | BROKER COMMISSION DENTAL COVERAGE | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $939 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $475 | | Additional information about fees paid to insurance broker | ADMINISTRATOR ORGAN TRANSPLANT | | Insurance broker organization code? | 5 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI50916 |
| Policy instance | 3 |
| Insurance contract or identification number | CLI50916 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $39,182 | | Total amount of fees paid to insurance company | USD $70,683 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $288,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,786 | | Amount paid for insurance broker fees | 67397 | | Additional information about fees paid to insurance broker | ADMINISTRATOR HEALTH PLAN | | Insurance broker organization code? | 5 |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI50916 |
| Policy instance | 3 |
| Insurance contract or identification number | CLI50916 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $38,369 | | Total amount of fees paid to insurance company | USD $66,678 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,347 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,123 | | Amount paid for insurance broker fees | 63442 | | Additional information about fees paid to insurance broker | ADMINISTRATOR HEALTH PLAN | | Insurance broker organization code? | 5 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $967 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $508 | | Additional information about fees paid to insurance broker | ADMINISTRATOR ORGAN TRANSPLANT | | Insurance broker organization code? | 5 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5735670 |
| Policy instance | 1 |
| Insurance contract or identification number | 5735670 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $7,940 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,558 | | Additional information about fees paid to insurance broker | BROKER COMMISSION DENTAL COVERAGE | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK962451 |
| Policy instance | 5 |
| Insurance contract or identification number | LK962451 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $5,628 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,940 | | Additional information about fees paid to insurance broker | BROKER LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963424 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX963424 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-29 | | Total amount of commissions paid to insurance broker | USD $7,091 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,964 | | Additional information about fees paid to insurance broker | BROKER LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| CAPROCK HEALTHPLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 031502 |
| Policy instance | 2 |
| Insurance contract or identification number | 031502 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $18,694 | | Total amount of fees paid to insurance company | USD $64,899 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,582 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 61693 | | Additional information about fees paid to insurance broker | ADMINISTRATOR HEALTH PLAN | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $13,086 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05735670 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05735670 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $7,640 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,348 | | Additional information about fees paid to insurance broker | BROKER FEE DENTAL COVERAGE | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 3 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $882 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $444 | | Additional information about fees paid to insurance broker | BROKER ORGAN TRANSPLANT | | Insurance broker organization code? | 3 |
|
| FAIR AMERICAN INS AND REINS CO. (National Association of Insurance Commissioners NAIC id number: 35157 ) |
| Policy contract number | MSL2000113-00 |
| Policy instance | 4 |
| Insurance contract or identification number | MSL2000113-00 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $4,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,663 | | Additional information about fees paid to insurance broker | ADMINISTRATOR STOP LOSS | | Insurance broker organization code? | 5 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK962451 |
| Policy instance | 6 |
| Insurance contract or identification number | LK962451 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $5,382 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,767 | | Additional information about fees paid to insurance broker | BROKER LONG-TERM DISABILITY | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963424 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX963424 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $6,796 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,757 | | Additional information about fees paid to insurance broker | BROKER LIFE INSURANCE | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GER-458 |
| Policy instance | 4 |
| Insurance contract or identification number | GER-458 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $11,884 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $144,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 3 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $829 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPROCK HEALTHPLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 031502 |
| Policy instance | 2 |
| Insurance contract or identification number | 031502 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $9,040 | | Total amount of fees paid to insurance company | USD $58,969 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05735670 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05735670 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $7,894 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK962451 |
| Policy instance | 6 |
| Insurance contract or identification number | LK962451 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $5,790 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963424 |
| Policy instance | 5 |
| Insurance contract or identification number | FLX963424 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $6,944 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX963424 |
| Policy instance | 3 |
| Insurance contract or identification number | FLX963424 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $6,050 | | Are there contracts with allocated funds for individual policies? | Yes | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,235 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | DENNIS G BRYAN INVESTMENT |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962451 |
| Policy instance | 4 |
| Insurance contract or identification number | LK 962451 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $5,793 | | Are there contracts with allocated funds for individual policies? | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,055 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | DENNIS G BRYAN INVESTMENT |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05735670 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05735670 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $6,456 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,519 | | Additional information about fees paid to insurance broker | BROKER FEE DENTAL COVERAGE | | Insurance broker organization code? | 3 | | Insurance broker name | DENNIS G BRYAN INVESTMENTS INC |
|
| HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2941300 |
| Policy instance | 1 |
| Insurance contract or identification number | 2941300 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2015-04-01 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | NUTA-1269 |
| Policy instance | 6 |
| Insurance contract or identification number | NUTA-1269 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Welfare Benefit Premiums Paid to Carrier | USD $164,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPROCK HEALTHPLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 031502 |
| Policy instance | 5 |
| Insurance contract or identification number | 031502 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Total amount of commissions paid to insurance broker | USD $17,892 | | Total amount of fees paid to insurance company | USD $61,252 | | Are there contracts with allocated funds for individual policies? | Yes | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,334 | | Amount paid for insurance broker fees | 284 | | Additional information about fees paid to insurance broker | BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CAPROCK HEALTHPLAN |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 7 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-29 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,685 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05735670 |
| Policy instance | 2 |
| Insurance contract or identification number | KM05735670 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $4,857 | | Total amount of fees paid to insurance company | USD $2,082 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,857 | | Amount paid for insurance broker fees | 2082 | | Additional information about fees paid to insurance broker | BROKER FEE DENTAL COVERAGE | | Insurance broker organization code? | 3 | | Insurance broker name | METROPOLITAN LIFE INSURANCE CO |
|
| HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2941300 |
| Policy instance | 3 |
| Insurance contract or identification number | 2941300 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of fees paid to insurance company | USD $24,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 24252 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEE HEALTH COVERAGE | | Insurance broker organization code? | 5 | | Insurance broker name | CIGNA PDM |
|
| HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2941300 |
| Policy instance | 1 |
| Insurance contract or identification number | 2941300 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of fees paid to insurance company | USD $3,942 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $301,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2759 | | Additional information about fees paid to insurance broker | BROKER FEE HEALTH COVERAGE | | Insurance broker organization code? | 3 | | Insurance broker name | DENNIS G BRYAN INVESTMENTS |
|
| HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2941300 |
| Policy instance | 1 |
| Insurance contract or identification number | 2941300 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of fees paid to insurance company | USD $21,259 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $171,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2134 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | CIGNA PDM |
|
| HEALTHSMART BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2941300 |
| Policy instance | 1 |
| Insurance contract or identification number | 2941300 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of fees paid to insurance company | USD $29,202 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $156,491 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1855 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 | | Insurance broker name | HEALTHSMART PREFERRED CARE |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GL-0016 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-0016 | | Number of Individuals Covered | 138 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $27,204 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $154,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 138 | | Insurance policy end date | 2012-02-29 | | Total amount of commissions paid to insurance broker | USD $1,121 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GL-0016 |
| Policy instance | 1 |
| Insurance contract or identification number | GL-0016 | | Number of Individuals Covered | 162 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $36,100 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $204,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000250 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 162 | | Insurance policy end date | 2011-02-28 | | Total amount of commissions paid to insurance broker | USD $1,280 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
