COOK CHILDRENS HEALTH CARE SYSTEM has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN
401k plan membership statisitcs for COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 8,511 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 9,150 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 28 |
| Total of all active and inactive participants | 2022-10-01 | 9,178 |
| Total participants | 2022-10-01 | 9,178 |
| 2021: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 7,358 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 7,829 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 48 |
| Total of all active and inactive participants | 2021-10-01 | 7,877 |
| Total participants | 2021-10-01 | 7,877 |
| 2020: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 7,449 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 7,320 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 38 |
| Total of all active and inactive participants | 2020-10-01 | 7,358 |
| Total participants | 2020-10-01 | 7,358 |
| 2019: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 7,613 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 7,402 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 47 |
| Total of all active and inactive participants | 2019-10-01 | 7,449 |
| Total participants | 2019-10-01 | 7,449 |
| 2018: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 6,861 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 7,564 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 49 |
| Total of all active and inactive participants | 2018-10-01 | 7,613 |
| Total participants | 2018-10-01 | 7,613 |
| 2017: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 5,876 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 6,846 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 15 |
| Total of all active and inactive participants | 2017-10-01 | 6,861 |
| Total participants | 2017-10-01 | 6,861 |
| 2016: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 5,854 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 22 |
| Total of all active and inactive participants | 2016-10-01 | 5,876 |
| Total participants | 2016-10-01 | 5,876 |
| 2022: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Submission has been amended | No |
| 2022-10-01 | This submission is the final filing | No |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-10-01 | Plan is a collectively bargained plan | No |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Submission has been amended | No |
| 2021-10-01 | This submission is the final filing | No |
| 2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-10-01 | Plan is a collectively bargained plan | No |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Submission has been amended | No |
| 2020-10-01 | This submission is the final filing | No |
| 2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-10-01 | Plan is a collectively bargained plan | No |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Submission has been amended | No |
| 2018-10-01 | This submission is the final filing | No |
| 2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-10-01 | Plan is a collectively bargained plan | No |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: COOK CHILDREN'S HEALTH CARE SYSTEM WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | First time form 5500 has been submitted | Yes |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 ) |
| Policy contract number | 8510301-G |
| Policy instance | 4 |
| Insurance contract or identification number | 8510301-G | | Number of Individuals Covered | 7997 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $53,279 | | Total amount of fees paid to insurance company | USD $62,278 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,331,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,279 | | Amount paid for insurance broker fees | 28978 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | | Insurance broker organization code? | 3 |
|
| SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 ) |
| Policy contract number | 0227703 |
| Policy instance | 3 |
| Insurance contract or identification number | 0227703 | | Number of Individuals Covered | 649 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 ) |
| Policy contract number | 8510301-G |
| Policy instance | 2 |
| Insurance contract or identification number | 8510301-G | | Number of Individuals Covered | 9149 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $90,600 | | Total amount of fees paid to insurance company | USD $105,902 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,265,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $90,600 | | Amount paid for insurance broker fees | 49277 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 039342 |
| Policy instance | 1 |
| Insurance contract or identification number | 039342 | | Number of Individuals Covered | 16304 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $831,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 ) |
| Policy contract number | 8510301-G |
| Policy instance | 1 |
| Insurance contract or identification number | 8510301-G | | Number of Individuals Covered | 8455 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $119,289 | | Total amount of fees paid to insurance company | USD $48,014 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,920,563 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $119,289 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 48014 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS |
|
| SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 ) |
| Policy contract number | 8510301-G |
| Policy instance | 2 |
| Insurance contract or identification number | 8510301-G | | Number of Individuals Covered | 6997 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $70,127 | | Total amount of fees paid to insurance company | USD $28,227 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,129,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,127 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 28227 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS |
|
| SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 ) |
| Policy contract number | 0227703 |
| Policy instance | 3 |
| Insurance contract or identification number | 0227703 | | Number of Individuals Covered | 606 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 039342 |
| Policy instance | 4 |
| Insurance contract or identification number | 039342 | | Number of Individuals Covered | 17497 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $773,552 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395123G |
| Policy instance | 4 |
| Insurance contract or identification number | 395123G | | Number of Individuals Covered | 7796 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $919,023 | | Total amount of fees paid to insurance company | USD $572,600 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,128,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $919,023 | | Amount paid for insurance broker fees | 162676 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS07078 |
| Policy instance | 3 |
| Insurance contract or identification number | ADDS07078 | | Number of Individuals Covered | 6677 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $17,194 | | Total amount of fees paid to insurance company | USD $10,116 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $245,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,194 | | Amount paid for insurance broker fees | 2316 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 039342 |
| Policy instance | 2 |
| Insurance contract or identification number | 039342 | | Number of Individuals Covered | 16112 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $779,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SAFEGUARD HEALTH PLANS, INC. A TEXAS CORPORATION (National Association of Insurance Commissioners NAIC id number: 95051 ) |
| Policy contract number | 0227703 |
| Policy instance | 1 |
| Insurance contract or identification number | 0227703 | | Number of Individuals Covered | 686 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,793 | | 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 | 0175388 |
| Policy instance | 5 |
| Insurance contract or identification number | 0175388 | | Number of Individuals Covered | 15077 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $736,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 04230 |
| Policy instance | 4 |
| Insurance contract or identification number | 04230 | | Number of Individuals Covered | 15171 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,479,937 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395123G |
| Policy instance | 3 |
| Insurance contract or identification number | 395123G | | Number of Individuals Covered | 7825 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $743,545 | | Total amount of fees paid to insurance company | USD $442,665 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,622,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $743,545 | | Amount paid for insurance broker fees | 176183 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS07078 |
| Policy instance | 2 |
| Insurance contract or identification number | ADDS07078 | | Number of Individuals Covered | 6720 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $13,959 | | Total amount of fees paid to insurance company | USD $5,852 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $199,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3377 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $13,959 |
|
| ALPHA DENTAL PROGRAMS, INC. (National Association of Insurance Commissioners NAIC id number: 95163 ) |
| Policy contract number | 76985 |
| Policy instance | 1 |
| Insurance contract or identification number | 76985 | | Number of Individuals Covered | 904 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 04230 |
| Policy instance | 1 |
| Insurance contract or identification number | 04230 | | Number of Individuals Covered | 14412 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,026,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395123G |
| Policy instance | 2 |
| Insurance contract or identification number | 395123G | | Number of Individuals Covered | 7303 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $529,609 | | Total amount of fees paid to insurance company | USD $337,096 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,355,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $529,609 | | Amount paid for insurance broker fees | 111242 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0175388 |
| Policy instance | 3 |
| Insurance contract or identification number | 0175388 | | Number of Individuals Covered | 6110 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $886,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS07078 |
| Policy instance | 4 |
| Insurance contract or identification number | ADDS07078 | | Number of Individuals Covered | 6628 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $12,242 | | Total amount of fees paid to insurance company | USD $5,854 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $174,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,242 | | Amount paid for insurance broker fees | 1995 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| ALPHA DENTAL PROGRAMS, INC. (National Association of Insurance Commissioners NAIC id number: 95163 ) |
| Policy contract number | 76985 |
| Policy instance | 5 |
| Insurance contract or identification number | 76985 | | Number of Individuals Covered | 693 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ALPHA DENTAL PROGRAMS, INC. (National Association of Insurance Commissioners NAIC id number: 95163 ) |
| Policy contract number | 76985 |
| Policy instance | 5 |
| Insurance contract or identification number | 76985 | | Number of Individuals Covered | 880 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 04230 |
| Policy instance | 4 |
| Insurance contract or identification number | 04230 | | Number of Individuals Covered | 14363 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,910,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ADDS07078 |
| Policy instance | 3 |
| Insurance contract or identification number | ADDS07078 | | Number of Individuals Covered | 6399 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $11,991 | | Total amount of fees paid to insurance company | USD $7,424 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $171,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395123G |
| Policy instance | 1 |
| Insurance contract or identification number | 395123G | | Number of Individuals Covered | 6397 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $627,626 | | Total amount of fees paid to insurance company | USD $433,435 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,176,357 | | 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 | 175388 |
| Policy instance | 2 |
| Insurance contract or identification number | 175388 | | Number of Individuals Covered | 13662 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $669,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
