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DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 401k Plan overview

Plan NameDENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN
Plan identification number 501

DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

DENNIS SEVEN DEES LANDSCAPING INC has sponsored the creation of one or more 401k plans.

Company Name:DENNIS SEVEN DEES LANDSCAPING INC
Employer identification number (EIN):930820720
NAIC Classification:238900

Additional information about DENNIS SEVEN DEES LANDSCAPING INC

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 1982-11-24
Company Identification Number: 16497919
Legal Registered Office Address: 7355 SE JOHNSON CRK BLVD

PORTLAND
United States of America (USA)
97206

More information about DENNIS SEVEN DEES LANDSCAPING INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01DANI GOWDA2023-05-01
5012021-01-01DANI GOWDA2022-03-15
5012020-01-01DANI GOWDA2021-06-23
5012019-04-01DANI POWELL2020-06-17
5012018-04-01DANI POWELL2019-10-28
5012017-04-01
5012016-04-01
5012015-04-01DEBBIE M. COLE
5012014-04-01DEBBIE M COLE
5012013-04-01P SCOTT THOMAS
5012012-04-01SCOTT THOMAS
5012012-02-01SCOTT THOMAS
5012011-02-01SCOTT THOMAS
5012009-02-01SCOTT THOMAS
5012008-02-01SCOTT THOMAS
5012007-02-01SCOTT THOMAS
5012006-02-01SCOTT THOMAS

Plan Statistics for DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN

401k plan membership statisitcs for DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN

Measure Date Value
2022: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01290
Total number of active participants reported on line 7a of the Form 55002022-01-01290
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01290
Number of employers contributing to the scheme2022-01-010
2021: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01249
Total number of active participants reported on line 7a of the Form 55002021-01-01290
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01290
Number of employers contributing to the scheme2021-01-010
2020: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01266
Total number of active participants reported on line 7a of the Form 55002020-01-01248
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-018
Total of all active and inactive participants2020-01-01257
Number of employers contributing to the scheme2020-01-010
2019: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01183
Total number of active participants reported on line 7a of the Form 55002019-04-01199
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01199
Number of employers contributing to the scheme2019-04-010
2018: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01199
Total number of active participants reported on line 7a of the Form 55002018-04-01187
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01187
Number of employers contributing to the scheme2018-04-010
2017: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01199
Total number of active participants reported on line 7a of the Form 55002017-04-01199
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01199
2016: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01180
Total number of active participants reported on line 7a of the Form 55002016-04-01199
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01199
2015: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01164
Total number of active participants reported on line 7a of the Form 55002015-04-01180
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01180
2014: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01164
Total number of active participants reported on line 7a of the Form 55002014-04-01162
Number of retired or separated participants receiving benefits2014-04-012
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01164
2013: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01141
Total number of active participants reported on line 7a of the Form 55002013-04-01155
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01155
2012: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01147
Total number of active participants reported on line 7a of the Form 55002012-04-01141
Total of all active and inactive participants2012-04-01141
Total participants, beginning-of-year2012-02-01147
Total number of active participants reported on line 7a of the Form 55002012-02-01147
Total of all active and inactive participants2012-02-01147
2011: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01169
Total number of active participants reported on line 7a of the Form 55002011-02-01157
Total of all active and inactive participants2011-02-01157
2009: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01177
Total number of active participants reported on line 7a of the Form 55002009-02-01169
Total of all active and inactive participants2009-02-01169
2008: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2008 401k membership
Total participants, beginning-of-year2008-02-01186
Total number of active participants reported on line 7a of the Form 55002008-02-01177
Total of all active and inactive participants2008-02-01177
2007: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-02-01189
Total number of active participants reported on line 7a of the Form 55002007-02-01186
Total of all active and inactive participants2007-02-01186
2006: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2006 401k membership
Total participants, beginning-of-year2006-02-01189
Total number of active participants reported on line 7a of the Form 55002006-02-01189
Total of all active and inactive participants2006-02-01189

Form 5500 Responses for DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN

2022: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2012-02-01Type of plan entitySingle employer plan
2012-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – General assets of the sponsorYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – General assets of the sponsorYes
2011: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2009: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – General assets of the sponsorYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – General assets of the sponsorYes
2008: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2008 form 5500 responses
2008-02-01Type of plan entitySingle employer plan
2008-02-01Plan funding arrangement – InsuranceYes
2008-02-01Plan funding arrangement – General assets of the sponsorYes
2008-02-01Plan benefit arrangement – InsuranceYes
2008-02-01Plan benefit arrangement – General assets of the sponsorYes
2007: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2007 form 5500 responses
2007-02-01Type of plan entitySingle employer plan
2007-02-01Plan funding arrangement – InsuranceYes
2007-02-01Plan funding arrangement – General assets of the sponsorYes
2007-02-01Plan benefit arrangement – InsuranceYes
2007-02-01Plan benefit arrangement – General assets of the sponsorYes
2006: DENNIS' SEVEN DEES LANDSCAPING, INC. EMPLOYEE HEALTHCARE PLAN 2006 form 5500 responses
2006-02-01Type of plan entitySingle employer plan
2006-02-01First time form 5500 has been submittedYes
2006-02-01Plan funding arrangement – InsuranceYes
2006-02-01Plan funding arrangement – General assets of the sponsorYes
2006-02-01Plan benefit arrangement – InsuranceYes
2006-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberDENNIS' SEVEN D
Policy instance 2
Insurance contract or identification numberDENNIS' SEVEN D
Number of Individuals Covered290
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number578939
Policy instance 1
Insurance contract or identification number578939
Number of Individuals Covered114
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,103
Total amount of fees paid to insurance companyUSD $2,373
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $64,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,103
Amount paid for insurance broker fees2373
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberDENNIS' SEVEN D
Policy instance 2
Insurance contract or identification numberDENNIS' SEVEN D
Number of Individuals Covered290
Insurance policy start date2021-11-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $1,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number578939
Policy instance 1
Insurance contract or identification number578939
Number of Individuals Covered123
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,958
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $59,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,333
Amount paid for insurance broker fees0
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberOPT01065-20
Policy instance 2
Insurance contract or identification numberOPT01065-20
Number of Individuals Covered201
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $18,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757684
Policy instance 1
Insurance contract or identification number757684
Number of Individuals Covered101
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,922
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,922
Amount paid for insurance broker fees0
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number757684
Policy instance 2
Insurance contract or identification number757684
Number of Individuals Covered155
Insurance policy start date2019-04-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $11,577
Total amount of fees paid to insurance companyUSD $2,990
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,577
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCCLOT40687
Policy instance 1
Insurance contract or identification numberHCCLOT40687
Number of Individuals Covered199
Insurance policy start date2019-04-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $15,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract numberOR300843
Policy instance 1
Insurance contract or identification numberOR300843
Number of Individuals Covered138
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $120,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number31554
Policy instance 2
Insurance contract or identification number31554
Number of Individuals Covered105
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract numberOR300843
Policy instance 1
Insurance contract or identification numberOR300843
Number of Individuals Covered134
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $2,997
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $120,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,997
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameBRATRUD MIDDLETON INS BROKERS INC
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract numberOR300843
Policy instance 1
Insurance contract or identification numberOR300843
Number of Individuals Covered125
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $3,634
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $112,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,634
Insurance broker organization code?3
Insurance broker nameBRATRUD MIDDLETON INS. BROKERS INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number1D026044
Policy instance 1
Insurance contract or identification number1D026044
Number of Individuals Covered109
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $76,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number108791
Policy instance 1
Insurance contract or identification number108791
Number of Individuals Covered208
Insurance policy start date2012-02-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $4,590
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,590
Insurance broker organization code?3
Insurance broker nameLAPORTE AND ASSOCIATES, INC.
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number108791
Policy instance 1
Insurance contract or identification number108791
Number of Individuals Covered208
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $16,096
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $599,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number108791
Policy instance 1
Insurance contract or identification number108791
Number of Individuals Covered160
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $16,959
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $599,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT WEST LIFE & INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number359000
Policy instance 1
Insurance contract or identification number359000
Number of Individuals Covered169
Insurance policy start date2009-02-01
Insurance policy end date2010-01-31
Total amount of commissions paid to insurance brokerUSD $506
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $506
Insurance broker organization code?3
Insurance broker nameLA PORTE & ASSOCIATES, INC.
GREAT WEST LIFE & INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number359000
Policy instance 1
Insurance contract or identification number359000
Number of Individuals Covered177
Insurance policy start date2008-02-01
Insurance policy end date2009-01-31
Total amount of commissions paid to insurance brokerUSD $499
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $499
Insurance broker organization code?3
Insurance broker nameLA PORTE & ASSOCIATES INC.
GREAT WEST LIFE & INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number359000
Policy instance 1
Insurance contract or identification number359000
Number of Individuals Covered186
Insurance policy start date2007-02-01
Insurance policy end date2008-01-31
Total amount of commissions paid to insurance brokerUSD $497
Total amount of fees paid to insurance companyUSD $2,420
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $497
Amount paid for insurance broker fees2420
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
Insurance broker nameLA PORTE & ASSOCIATES INC
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number359000
Policy instance 1
Insurance contract or identification number359000
Number of Individuals Covered189
Insurance policy start date2006-04-01
Insurance policy end date2007-01-31
Total amount of commissions paid to insurance brokerUSD $423
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Insurance broker organization code?3
Insurance broker nameLA PORTE & ASSOCIATES

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