PCA- PRIMARY CARE ASSOCIATES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN
401k plan membership statisitcs for PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN
Measure | Date | Value |
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2016: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-11-01 | 8 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 0 |
Number of retired or separated participants receiving benefits | 2016-11-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 0 |
Total of all active and inactive participants | 2016-11-01 | 0 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-11-01 | 0 |
Total participants | 2016-11-01 | 0 |
Number of participants with account balances | 2016-11-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-11-01 | 0 |
Number of employers contributing to the scheme | 2016-11-01 | 0 |
2015: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-11-01 | 205 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 8 |
Total of all active and inactive participants | 2015-11-01 | 8 |
Total participants | 2015-11-01 | 8 |
2014: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-11-01 | 207 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 204 |
Number of retired or separated participants receiving benefits | 2014-11-01 | 1 |
Total of all active and inactive participants | 2014-11-01 | 205 |
Total participants | 2014-11-01 | 205 |
2013: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-11-01 | 219 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 207 |
Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
Total of all active and inactive participants | 2013-11-01 | 207 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-11-01 | 0 |
Total participants | 2013-11-01 | 207 |
2012: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-11-01 | 213 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 219 |
Total of all active and inactive participants | 2012-11-01 | 219 |
Total participants | 2012-11-01 | 219 |
2011: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-11-01 | 216 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 211 |
Number of retired or separated participants receiving benefits | 2011-11-01 | 2 |
Total of all active and inactive participants | 2011-11-01 | 213 |
Total participants | 2011-11-01 | 213 |
2009: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-11-01 | 224 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 240 |
Number of retired or separated participants receiving benefits | 2009-11-01 | 3 |
Total of all active and inactive participants | 2009-11-01 | 243 |
Total participants | 2009-11-01 | 243 |
2008: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-11-01 | 212 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-11-01 | 224 |
Total of all active and inactive participants | 2008-11-01 | 224 |
Total participants | 2008-11-01 | 224 |
2016: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses |
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2016-11-01 | Type of plan entity | Single employer plan |
2016-11-01 | Submission has been amended | No |
2016-11-01 | This submission is the final filing | Yes |
2016-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-11-01 | Plan is a collectively bargained plan | No |
2016-11-01 | Plan funding arrangement – Insurance | Yes |
2016-11-01 | Plan benefit arrangement – Insurance | Yes |
2015: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses |
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2015-11-01 | Type of plan entity | Single employer plan |
2015-11-01 | Submission has been amended | No |
2015-11-01 | This submission is the final filing | No |
2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-11-01 | Plan is a collectively bargained plan | No |
2015-11-01 | Plan funding arrangement – Insurance | Yes |
2015-11-01 | Plan benefit arrangement – Insurance | Yes |
2014: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses |
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2014-11-01 | Type of plan entity | Single employer plan |
2014-11-01 | Submission has been amended | No |
2014-11-01 | This submission is the final filing | No |
2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-11-01 | Plan is a collectively bargained plan | No |
2014-11-01 | Plan funding arrangement – Insurance | Yes |
2014-11-01 | Plan benefit arrangement – Insurance | Yes |
2013: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses |
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2013-11-01 | Type of plan entity | Single employer plan |
2013-11-01 | Submission has been amended | No |
2013-11-01 | This submission is the final filing | No |
2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-11-01 | Plan is a collectively bargained plan | No |
2013-11-01 | Plan funding arrangement – Insurance | Yes |
2013-11-01 | Plan benefit arrangement – Insurance | Yes |
2012: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses |
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2012-11-01 | Type of plan entity | Single employer plan |
2012-11-01 | Submission has been amended | No |
2012-11-01 | This submission is the final filing | No |
2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-11-01 | Plan is a collectively bargained plan | No |
2012-11-01 | Plan funding arrangement – Insurance | Yes |
2012-11-01 | Plan benefit arrangement – Insurance | Yes |
2011: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses |
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2011-11-01 | Type of plan entity | Single employer plan |
2011-11-01 | Submission has been amended | No |
2011-11-01 | This submission is the final filing | No |
2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-11-01 | Plan is a collectively bargained plan | No |
2011-11-01 | Plan funding arrangement – Insurance | Yes |
2011-11-01 | Plan benefit arrangement – Insurance | Yes |
2009: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses |
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2009-11-01 | Type of plan entity | Single employer plan |
2009-11-01 | Submission has been amended | No |
2009-11-01 | This submission is the final filing | No |
2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-11-01 | Plan is a collectively bargained plan | No |
2009-11-01 | Plan funding arrangement – Insurance | Yes |
2009-11-01 | Plan benefit arrangement – Insurance | Yes |
2008: PCA-PRIMARY CARE ASSOCIATES HEALTH & WELFARE BENEFIT PLAN 2008 form 5500 responses |
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2008-11-01 | Type of plan entity | Single employer plan |
2008-11-01 | Submission has been amended | No |
2008-11-01 | This submission is the final filing | No |
2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-11-01 | Plan is a collectively bargained plan | No |
2008-11-01 | Plan funding arrangement – Insurance | Yes |
2008-11-01 | Plan benefit arrangement – Insurance | Yes |
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJM |
Policy instance | 1 |
Insurance contract or identification number | G000AHJM | Number of Individuals Covered | 164 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $988 | Total amount of fees paid to insurance company | USD $326 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,586 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $988 | Amount paid for insurance broker fees | 326 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
Policy contract number | 330060 |
Policy instance | 2 |
Insurance contract or identification number | 330060 | Number of Individuals Covered | 190 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of fees paid to insurance company | USD $860 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,852 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 860 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | D5K18 |
Policy instance | 3 |
Insurance contract or identification number | D5K18 | Number of Individuals Covered | 21 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $10,968 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 4 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 109 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $6,901 | Total amount of fees paid to insurance company | USD $1,916 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $46,010 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,901 | Amount paid for insurance broker fees | 1916 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 5 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 101 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $4,579 | Total amount of fees paid to insurance company | USD $1,372 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $30,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,579 | Amount paid for insurance broker fees | 1372 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995551 |
Policy instance | 6 |
Insurance contract or identification number | KM05995551 | Number of Individuals Covered | 331 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $8,412 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $85,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,412 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 053546 |
Policy instance | 7 |
Insurance contract or identification number | 053546 | Number of Individuals Covered | 204 | Insurance policy start date | 2014-11-01 | Insurance policy end date | 2015-10-31 | Total amount of commissions paid to insurance broker | USD $50,428 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,296,320 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,889 | Insurance broker organization code? | 3 | Insurance broker name | FIRST INS AN AFFILATE OF FIRST BANK |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 6 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 112 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $5,819 | Total amount of fees paid to insurance company | USD $1,854 | Other welfare benefits provided | PREFERRED CHOICE VOLUNTARY STD | Welfare Benefit Premiums Paid to Carrier | USD $38,795 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,418 | Amount paid for insurance broker fees | 1854 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJM |
Policy instance | 5 |
Insurance contract or identification number | G000AHJM | Number of Individuals Covered | 108 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $4,350 | Total amount of fees paid to insurance company | USD $1,431 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D-VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $29,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,859 | Amount paid for insurance broker fees | 1431 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
Policy contract number | 330060 |
Policy instance | 4 |
Insurance contract or identification number | 330060 | Number of Individuals Covered | 204 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $1,362 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,427 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,362 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 53546 |
Policy instance | 3 |
Insurance contract or identification number | 53546 | Number of Individuals Covered | 207 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $50,464 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,288,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $50,464 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995551 |
Policy instance | 2 |
Insurance contract or identification number | KM05995551 | Number of Individuals Covered | 334 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $8,498 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $91,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,498 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | D5K18 |
Policy instance | 1 |
Insurance contract or identification number | D5K18 | Number of Individuals Covered | 21 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $2,430 | Total amount of fees paid to insurance company | USD $33 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $13,580 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,485 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 11 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker name | DAVID M COUGLIN |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 7 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 172 | Insurance policy start date | 2013-11-01 | Insurance policy end date | 2014-10-31 | Total amount of commissions paid to insurance broker | USD $1,051 | Total amount of fees paid to insurance company | USD $305 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,008 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $177 | Amount paid for insurance broker fees | 305 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | FIRST INSURANCE |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05995551 |
Policy instance | 1 |
Insurance contract or identification number | KM05995551 | Number of Individuals Covered | 345 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $7,613 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $76,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,613 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJM |
Policy instance | 7 |
Insurance contract or identification number | G000AHJM | Number of Individuals Covered | 169 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-11-01 | Total amount of commissions paid to insurance broker | USD $942 | Total amount of fees paid to insurance company | USD $304 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $6,283 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $942 | Amount paid for insurance broker fees | 304 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | D5K18 |
Policy instance | 6 |
Insurance contract or identification number | D5K18 | Number of Individuals Covered | 27 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $2,549 | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $13,345 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,461 | Insurance broker organization code? | 3 | Insurance broker name | LARRY D DENNY |
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BLOCK VISION (National Association of Insurance Commissioners NAIC id number: 95387 ) |
Policy contract number | 330060 |
Policy instance | 5 |
Insurance contract or identification number | 330060 | Number of Individuals Covered | 99 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $1,321 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,371 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,321 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 4 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 114 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-11-01 | Total amount of commissions paid to insurance broker | USD $4,561 | Total amount of fees paid to insurance company | USD $1,375 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D-VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $30,405 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,561 | Amount paid for insurance broker fees | 1375 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJL |
Policy instance | 3 |
Insurance contract or identification number | G000AHJL | Number of Individuals Covered | 121 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-11-01 | Total amount of commissions paid to insurance broker | USD $5,938 | Total amount of fees paid to insurance company | USD $1,748 | Other welfare benefits provided | STD | Welfare Benefit Premiums Paid to Carrier | USD $39,586 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,938 | Amount paid for insurance broker fees | 1748 | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 053546 |
Policy instance | 2 |
Insurance contract or identification number | 053546 | Number of Individuals Covered | 219 | Insurance policy start date | 2012-11-01 | Insurance policy end date | 2013-10-31 | Total amount of commissions paid to insurance broker | USD $42,426 | Total amount of fees paid to insurance company | USD $1,305 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,060,587 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,426 | Amount paid for insurance broker fees | 1305 | Additional information about fees paid to insurance broker | CONSULTANT FEES | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE BY DESIGN INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AHJM |
Policy instance | 3 |
Insurance contract or identification number | GLUG0AHJM | Number of Individuals Covered | 166 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $10,625 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D AND STD | Welfare Benefit Premiums Paid to Carrier | USD $70,840 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | GFZ02977 |
Policy instance | 2 |
Insurance contract or identification number | GFZ02977 | Number of Individuals Covered | 70 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $7,616 | Total amount of fees paid to insurance company | USD $148 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $76,487 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 053546 |
Policy instance | 1 |
Insurance contract or identification number | 053546 | Number of Individuals Covered | 211 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $42,383 | Total amount of fees paid to insurance company | USD $1,800 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,063,182 | 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 | 463405 |
Policy instance | 4 |
Insurance contract or identification number | 463405 | Number of Individuals Covered | 109 | Insurance policy start date | 2011-11-01 | Insurance policy end date | 2012-10-31 | Total amount of commissions paid to insurance broker | USD $1,661 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,139 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000AHJM |
Policy instance | 4 |
Insurance contract or identification number | G000AHJM | Number of Individuals Covered | 164 | Insurance policy start date | 2010-11-01 | Insurance policy end date | 2011-10-31 | Total amount of commissions paid to insurance broker | USD $12,996 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, STD | Welfare Benefit Premiums Paid to Carrier | USD $74,660 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | GFZ02977 |
Policy instance | 3 |
Insurance contract or identification number | GFZ02977 | Number of Individuals Covered | 120 | Insurance policy start date | 2010-11-01 | Insurance policy end date | 2011-10-31 | Total amount of commissions paid to insurance broker | USD $7,281 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $72,809 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 053546 |
Policy instance | 1 |
Insurance contract or identification number | 053546 | Number of Individuals Covered | 216 | Insurance policy start date | 2010-11-01 | Insurance policy end date | 2011-10-31 | Total amount of commissions paid to insurance broker | USD $40,812 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,023,478 | 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 | 463405 |
Policy instance | 2 |
Insurance contract or identification number | 463405 | Number of Individuals Covered | 172 | Insurance policy start date | 2010-11-01 | Insurance policy end date | 2011-10-31 | Total amount of commissions paid to insurance broker | USD $1,739 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,852 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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