THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN
401k plan membership statisitcs for THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN
| Measure | Date | Value |
|---|
| 2020: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 25 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 25 |
| 2019: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 125 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 125 |
| 2018: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 129 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 129 |
| 2017: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 131 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 131 |
| 2016: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 129 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 129 |
| 2015: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 124 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 124 |
| 2014: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 117 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 117 |
| 2013: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 113 |
| Number of retired or separated participants receiving benefits | 2013-06-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2013-06-01 | 0 |
| Total of all active and inactive participants | 2013-06-01 | 114 |
| 2012: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 123 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-06-01 | 0 |
| Total of all active and inactive participants | 2012-06-01 | 123 |
| 2011: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 124 |
| Number of retired or separated participants receiving benefits | 2011-06-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2011-06-01 | 0 |
| Total of all active and inactive participants | 2011-06-01 | 125 |
| 2009: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 131 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 131 |
| Total participants | 2009-06-01 | 0 |
| 2020: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Submission has been amended | No |
| 2020-06-01 | This submission is the final filing | No |
| 2020-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-06-01 | Plan is a collectively bargained plan | No |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Submission has been amended | No |
| 2019-06-01 | This submission is the final filing | No |
| 2019-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-06-01 | Plan is a collectively bargained plan | No |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Submission has been amended | No |
| 2018-06-01 | This submission is the final filing | No |
| 2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-06-01 | Plan is a collectively bargained plan | No |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Submission has been amended | No |
| 2017-06-01 | This submission is the final filing | No |
| 2017-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-06-01 | Plan is a collectively bargained plan | No |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | Submission has been amended | No |
| 2016-06-01 | This submission is the final filing | No |
| 2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-06-01 | Plan is a collectively bargained plan | No |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Submission has been amended | No |
| 2015-06-01 | This submission is the final filing | No |
| 2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-06-01 | Plan is a collectively bargained plan | No |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Submission has been amended | No |
| 2014-06-01 | This submission is the final filing | No |
| 2014-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-06-01 | Plan is a collectively bargained plan | No |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Submission has been amended | No |
| 2013-06-01 | This submission is the final filing | No |
| 2013-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-06-01 | Plan is a collectively bargained plan | No |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Submission has been amended | No |
| 2012-06-01 | This submission is the final filing | No |
| 2012-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-06-01 | Plan is a collectively bargained plan | No |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Submission has been amended | No |
| 2011-06-01 | This submission is the final filing | No |
| 2011-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-06-01 | Plan is a collectively bargained plan | No |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: THE ARIZONA INN COMPANY LIMITED PARTNERSHIP LLP FLEXIBLE COMPENSATION PLAN 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Submission has been amended | No |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-06-01 | Plan is a collectively bargained plan | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 4 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 23 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $192 | | Amount paid for insurance broker fees | 102 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 1485, 9484 |
| Policy instance | 3 |
| Insurance contract or identification number | 1485, 9484 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $947 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $947 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 2 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Insurance broker organization code? | 3 |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 37678 |
| Policy instance | 1 |
| Insurance contract or identification number | 37678 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $400 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $400 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $22,612 | | 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 $453,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,612 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 131 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $270 | | Total amount of fees paid to insurance company | USD $123 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $270 | | Amount paid for insurance broker fees | 123 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 129 | | Insurance policy start date | 2016-08-01 | | Insurance policy end date | 2017-07-31 | | Total amount of commissions paid to insurance broker | USD $283 | | Total amount of fees paid to insurance company | USD $99 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,835 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2016-08-01 | | Insurance policy end date | 2017-07-31 | | Total amount of commissions paid to insurance broker | USD $23,181 | | 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 $464,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $18,907 | | 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 $377,729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,907 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $266 | | Total amount of fees paid to insurance company | USD $119 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $266 | | Amount paid for insurance broker fees | 119 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 1485, 9484 |
| Policy instance | 3 |
| Insurance contract or identification number | 1485, 9484 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $895 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $895 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 127 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $256 | | Total amount of fees paid to insurance company | USD $117 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $256 | | Amount paid for insurance broker fees | 117 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $15,826 | | 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 $350,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,826 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 1485, 9484 |
| Policy instance | 3 |
| Insurance contract or identification number | 1485, 9484 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $990 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $990 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 001485 |
| Policy instance | 3 |
| Insurance contract or identification number | 001485 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $1,015 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,015 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 113 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $235 | | Total amount of fees paid to insurance company | USD $87 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $235 | | Amount paid for insurance broker fees | 87 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $14,027 | | 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 $305,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,027 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $23,768 | | 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 $315,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,768 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 001485 |
| Policy instance | 3 |
| Insurance contract or identification number | 001485 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $1,140 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,140 | | Insurance broker organization code? | 3 | | Are there contracts with allocated funds for individual policies? | Yes | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 123 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $372 | | 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 $2,533 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $372 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 001485 |
| Policy instance | 3 |
| Insurance contract or identification number | 001485 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,295 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,301 | | 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 | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 130 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $360 | | 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 $2,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $15,476 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $309,516 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) |
| Policy contract number | 001485 |
| Policy instance | 3 |
| Insurance contract or identification number | 001485 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $1,271 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,271 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 ) |
| Policy contract number | 27332 |
| Policy instance | 1 |
| Insurance contract or identification number | 27332 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $15,908 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $318,164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,908 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ADIR |
| Policy instance | 2 |
| Insurance contract or identification number | G000ADIR | | Number of Individuals Covered | 131 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $356 | | 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 $2,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $356 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS AND INSURANCE SERVICE |
|
