COMMUNITY DEVELOPMENT INSTITUTE HEAD START has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY
401k plan membership statisitcs for COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY
| Measure | Date | Value |
|---|
| 2022: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 732 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 538 |
| Total of all active and inactive participants | 2022-07-01 | 538 |
| 2021: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 835 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 732 |
| Total of all active and inactive participants | 2021-07-01 | 732 |
| 2020: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 3,049 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 835 |
| Total of all active and inactive participants | 2020-07-01 | 835 |
| 2019: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 2,769 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 3,049 |
| Total of all active and inactive participants | 2019-07-01 | 3,049 |
| 2017: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 1,214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 1,791 |
| Total of all active and inactive participants | 2017-07-01 | 1,791 |
| 2016: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 1,952 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 1,214 |
| Total of all active and inactive participants | 2016-07-01 | 1,214 |
| 2015: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 1,952 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 1,952 |
| Total of all active and inactive participants | 2015-07-01 | 1,952 |
| 2014: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 2,557 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 2,418 |
| Total of all active and inactive participants | 2014-07-01 | 2,418 |
| 2013: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 2,226 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 2,557 |
| Total of all active and inactive participants | 2013-07-01 | 2,557 |
| 2012: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 2,799 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 2,226 |
| Total of all active and inactive participants | 2012-07-01 | 2,226 |
| 2011: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 2,665 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 2,799 |
| Total of all active and inactive participants | 2011-07-01 | 2,799 |
| 2010: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 2,591 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 2,665 |
| Total of all active and inactive participants | 2010-07-01 | 2,665 |
| Total participants | 2010-07-01 | 2,665 |
| 2009: COMMUNITY DEVELOPMENT INSTITUTE GROUP MEDICAL, DENTAL, & LIFE INSURANCE FOR EMPLOY 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 2,093 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 2,591 |
| Total of all active and inactive participants | 2009-07-01 | 2,591 |
| Total participants | 2009-07-01 | 2,591 |
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 5 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 805 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $1,018 | | Total amount of fees paid to insurance company | USD $167 | | Vision 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 $1,018 | | Amount paid for insurance broker fees | 167 | | Insurance broker organization code? | 4 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 4 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 389 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $62,345 | | Total amount of fees paid to insurance company | USD $81 | | 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 $62,345 | | Amount paid for insurance broker fees | 81 | | Insurance broker organization code? | 4 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000-17045 |
| Policy instance | 3 |
| Insurance contract or identification number | 400001000-17045 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $9 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $62 | | 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 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010178354 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010178354 | | Number of Individuals Covered | 538 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $5,794 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $38,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,794 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000000011283 |
| Policy instance | 1 |
| Insurance contract or identification number | 000000011283 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $3,891 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $3,891 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000000011283 |
| Policy instance | 1 |
| Insurance contract or identification number | 000000011283 | | Number of Individuals Covered | 622 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $8,266 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $8,266 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010178354 |
| Policy instance | 2 |
| Insurance contract or identification number | 000010178354 | | Number of Individuals Covered | 732 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $6,741 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $44,942 | | 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 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000-17045 |
| Policy instance | 3 |
| Insurance contract or identification number | 400001000-17045 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $108 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108 | | Insurance broker organization code? | 3 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 4 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 505 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $31,954 | | Total amount of fees paid to insurance company | USD $409 | | 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 $31,954 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 409 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 5 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 524 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $33,156 | | Total amount of fees paid to insurance company | USD $424 | | Vision 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 $33,156 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 424 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 1 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 835 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $25,098 | | Total amount of fees paid to insurance company | USD $5,124 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $167,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,098 | | Amount paid for insurance broker fees | 5124 | | Insurance broker organization code? | 3 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 2 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 587 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $149,556 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,199,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $149,556 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000011283 |
| Policy instance | 3 |
| Insurance contract or identification number | 000011283 | | Number of Individuals Covered | 707 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $11,129 | | Total amount of fees paid to insurance company | USD $0 | | Dental 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 $11,129 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 4 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 598 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $991 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $991 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010233895 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010233895 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $2,478 | | Total amount of fees paid to insurance company | USD $141 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,478 | | Amount paid for insurance broker fees | 141 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 17045 |
| Policy instance | 6 |
| Insurance contract or identification number | 400001000 17045 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $8,944 | | Total amount of fees paid to insurance company | USD $1,651 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $59,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,944 | | Amount paid for insurance broker fees | 1651 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 17045 |
| Policy instance | 6 |
| Insurance contract or identification number | 400001000 17045 | | Number of Individuals Covered | 1668 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $8,735 | | Total amount of fees paid to insurance company | USD $16 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $58,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010233895 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010233895 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,206 | | Total amount of fees paid to insurance company | USD $134 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 4 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 2045 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $2,172 | | Total amount of fees paid to insurance company | USD $7 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000011283 |
| Policy instance | 3 |
| Insurance contract or identification number | 000011283 | | Number of Individuals Covered | 2524 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $22,000 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 2 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 1867 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $267,766 | | Total amount of fees paid to insurance company | USD $913 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,274,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 1 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 3049 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $33,594 | | Total amount of fees paid to insurance company | USD $1,915 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $223,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000011283 |
| Policy instance | 3 |
| Insurance contract or identification number | 000011283 | | Number of Individuals Covered | 2442 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $12,939 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $265,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 2 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 2286 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $176,447 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,221,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 1 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 1791 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $16,725 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SPOUSE & DEPENDENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 1 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 1952 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $18,650 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SPOUSE & DEPENDENT | | Welfare Benefit Premiums Paid to Carrier | USD $124,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,650 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 2 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 1069 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $148,111 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,945,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $145,564 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000011283 |
| Policy instance | 3 |
| Insurance contract or identification number | 000011283 | | Number of Individuals Covered | 1152 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $10,810 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $223,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,810 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN & BROWN OF PENNSYLVANIA LP |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 2 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 1021 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $195,854 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,217,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $195,854 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 1 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 2418 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $28,280 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $162,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,310 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | BROWN AND BROWN OF FLORIDA |
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| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 000011283 |
| Policy instance | 3 |
| Insurance contract or identification number | 000011283 | | Number of Individuals Covered | 1657 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $17,964 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $354,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,964 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
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| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 1 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 1518 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $296,840 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $104,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $296,840 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA, IN |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10178354 |
| Policy instance | 2 |
| Insurance contract or identification number | 10178354 | | Number of Individuals Covered | 2557 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $31,334 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $208,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,334 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA, IN |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 01380892 |
| Policy instance | 2 |
| Insurance contract or identification number | 01380892 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $2,510 | | Total amount of fees paid to insurance company | USD $377 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental 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 $2,510 | | Amount paid for insurance broker fees | 377 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA, IN |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 121654 |
| Policy instance | 3 |
| Insurance contract or identification number | 121654 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $8,998 | | Total amount of fees paid to insurance company | USD $758 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 $92,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,998 | | Amount paid for insurance broker fees | 758 | | Additional information about fees paid to insurance broker | COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA, IN |
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| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 1 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 2226 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $254,251 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,269,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $254,251 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA, IN |
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| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 1 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 2799 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $307,579 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,818,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 121654 |
| Policy instance | 2 |
| Insurance contract or identification number | 121654 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-07-01 | | Total amount of commissions paid to insurance broker | USD $7,636 | | Total amount of fees paid to insurance company | USD $618 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,353 | | 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 | 0138092 |
| Policy instance | 4 |
| Insurance contract or identification number | 0138092 | | Number of Individuals Covered | 2665 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $24,101 | | Total amount of fees paid to insurance company | USD $9,640 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $484,174 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0138092 |
| Policy instance | 1 |
| Insurance contract or identification number | 0138092 | | Number of Individuals Covered | 2665 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $1,071 | | Total amount of fees paid to insurance company | USD $428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 125474 |
| Policy instance | 2 |
| Insurance contract or identification number | 125474 | | Number of Individuals Covered | 3052 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-06-01 | | Total amount of commissions paid to insurance broker | USD $3,085 | | Total amount of fees paid to insurance company | USD $551 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $127,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 195760 |
| Policy instance | 3 |
| Insurance contract or identification number | 195760 | | Number of Individuals Covered | 2591 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $274,162 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,910,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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