VIRGINIA GARCIA MEMORIAL HEALTH CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN
401k plan membership statisitcs for VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2022: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 563 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 431 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 431 |
| 2021: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 538 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 499 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
| Total of all active and inactive participants | 2021-04-01 | 499 |
| 2020: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 538 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 499 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
| Total of all active and inactive participants | 2020-04-01 | 499 |
| 2019: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 582 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 510 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 510 |
| 2018: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 552 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 591 |
| Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
| Total of all active and inactive participants | 2018-04-01 | 591 |
| 2017: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 512 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 552 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
| Total of all active and inactive participants | 2017-04-01 | 552 |
| 2016: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 487 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 504 |
| Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 6 |
| Total of all active and inactive participants | 2016-04-01 | 510 |
| 2015: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 456 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
| Total of all active and inactive participants | 2015-04-01 | 457 |
| 2014: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 346 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 343 |
| Total of all active and inactive participants | 2014-04-01 | 343 |
| 2013: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 255 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 346 |
| Total of all active and inactive participants | 2013-04-01 | 346 |
| 2012: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 255 |
| Total of all active and inactive participants | 2012-04-01 | 255 |
| 2011: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 243 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 254 |
| Total of all active and inactive participants | 2011-04-01 | 254 |
| 2010: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-04-01 | 233 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 243 |
| Total of all active and inactive participants | 2010-04-01 | 243 |
| 2009: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 233 |
| Number of retired or separated participants receiving benefits | 2009-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
| Total of all active and inactive participants | 2009-04-01 | 233 |
| 2022: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Submission has been amended | No |
| 2015-04-01 | This submission is the final filing | No |
| 2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-04-01 | Plan is a collectively bargained plan | No |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2010 form 5500 responses |
|---|
| 2010-04-01 | Type of plan entity | Single employer plan |
| 2010-04-01 | Plan funding arrangement – Insurance | Yes |
| 2010-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: VIRGINIA GARCIA MEMORIAL HEALTH CENTER 125 CAFETERIA PLAN 2009 form 5500 responses |
|---|
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | This submission is the final filing | No |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
| Policy contract number | VIRGINIA GARCIA |
| Policy instance | 5 |
| Insurance contract or identification number | VIRGINIA GARCIA | | Number of Individuals Covered | 587 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $12,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $10,007 | | Total amount of fees paid to insurance company | USD $1,334 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,007 | | Amount paid for insurance broker fees | 1334 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 881069 |
| Policy instance | 3 |
| Insurance contract or identification number | 881069 | | Number of Individuals Covered | 618 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of fees paid to insurance company | USD $3,193 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3193 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 563 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of fees paid to insurance company | USD $3,197 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $159,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3197 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 1001 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of fees paid to insurance company | USD $5,557 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,002,784 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5557 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 995 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of fees paid to insurance company | USD $11,340 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,560,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 11340 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 511 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of fees paid to insurance company | USD $3,180 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $159,019 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3180 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 881069 |
| Policy instance | 3 |
| Insurance contract or identification number | 881069 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of fees paid to insurance company | USD $2,321 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2321 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $9,818 | | Total amount of fees paid to insurance company | USD $1,309 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,818 | | Amount paid for insurance broker fees | 1309 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $9,667 | | Total amount of fees paid to insurance company | USD $924 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,667 | | Amount paid for insurance broker fees | 924 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 881069 |
| Policy instance | 3 |
| Insurance contract or identification number | 881069 | | Number of Individuals Covered | 594 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of fees paid to insurance company | USD $1,342 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1342 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of fees paid to insurance company | USD $2,193 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $152,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2193 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 1048 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of fees paid to insurance company | USD $6,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,842,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6000 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 505 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of fees paid to insurance company | USD $1,573 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $161,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1573 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 1061 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of fees paid to insurance company | USD $11,387 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,669,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 11387 | | Additional information about fees paid to insurance broker | RETENTION BONUS NON-MONETARY COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 881069 |
| Policy instance | 3 |
| Insurance contract or identification number | 881069 | | Number of Individuals Covered | 560 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of fees paid to insurance company | USD $500 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,522 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 500 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $10,633 | | Total amount of fees paid to insurance company | USD $530 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,633 | | Amount paid for insurance broker fees | 530 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,711 | | Total amount of fees paid to insurance company | USD $306 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,711 | | Amount paid for insurance broker fees | 306 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $1,301 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $211,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1301 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 1099 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of fees paid to insurance company | USD $5,266 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,360,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5266 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 152972 |
| Policy instance | 3 |
| Insurance contract or identification number | 152972 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,491 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,372 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800675 |
| Policy instance | 4 |
| Insurance contract or identification number | 800675 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,382 | | Total amount of fees paid to insurance company | USD $664 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,382 | | Amount paid for insurance broker fees | 664 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 152972 |
| Policy instance | 3 |
| Insurance contract or identification number | 152972 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,729 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,346 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADDTL COMP | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 800674 |
| Policy instance | 2 |
| Insurance contract or identification number | 800674 | | Number of Individuals Covered | 512 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,672 | | Total amount of fees paid to insurance company | USD $2,602 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $192,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,672 | | Amount paid for insurance broker fees | 2602 | | Additional information about fees paid to insurance broker | ADDITIONAL COMP | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
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| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 16145 |
| Policy instance | 1 |
| Insurance contract or identification number | 16145 | | Number of Individuals Covered | 1030 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $10,504 | | Total amount of fees paid to insurance company | USD $5,196 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,819,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,504 | | Amount paid for insurance broker fees | 5196 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | DAVIDSON BENEFITS PLANNING LLC |
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