WALTERS WHOLESALE ELECTRIC CO. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN
401k plan membership statisitcs for WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN
| Measure | Date | Value |
|---|
| 2022: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 448 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 448 |
| 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 | 448 |
| 2021: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 500 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 448 |
| Total of all active and inactive participants | 2021-04-01 | 448 |
| Total participants | 2021-04-01 | 448 |
| 2020: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 540 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 500 |
| Total of all active and inactive participants | 2020-04-01 | 500 |
| Total participants | 2020-04-01 | 500 |
| 2019: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 527 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 540 |
| Total of all active and inactive participants | 2019-04-01 | 540 |
| Total participants | 2019-04-01 | 540 |
| 2018: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 520 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 527 |
| Total of all active and inactive participants | 2018-04-01 | 527 |
| Total participants | 2018-04-01 | 527 |
| 2017: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 454 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 520 |
| Total of all active and inactive participants | 2017-04-01 | 520 |
| Total participants | 2017-04-01 | 520 |
| 2016: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 455 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 454 |
| Total of all active and inactive participants | 2016-04-01 | 454 |
| Total participants | 2016-04-01 | 454 |
| 2015: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 440 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 456 |
| Total of all active and inactive participants | 2015-04-01 | 456 |
| Total participants | 2015-04-01 | 0 |
| 2014: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 462 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 440 |
| Total of all active and inactive participants | 2014-04-01 | 440 |
| Total participants | 2014-04-01 | 0 |
| 2013: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 451 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 462 |
| Total of all active and inactive participants | 2013-04-01 | 462 |
| Total participants | 2013-04-01 | 0 |
| 2012: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 436 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 451 |
| Total of all active and inactive participants | 2012-04-01 | 451 |
| Total participants | 2012-04-01 | 0 |
| 2011: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 423 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 436 |
| Total of all active and inactive participants | 2011-04-01 | 436 |
| Total participants | 2011-04-01 | 436 |
| 2010: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-04-01 | 449 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 423 |
| Total of all active and inactive participants | 2010-04-01 | 423 |
| Total participants | 2010-04-01 | 423 |
| 2009: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 477 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 449 |
| Total of all active and inactive participants | 2009-04-01 | 449 |
| Total participants | 2009-04-01 | 449 |
| 2022: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Submission has been amended | No |
| 2022-04-01 | This submission is the final filing | No |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-01 | Plan is a collectively bargained plan | No |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL 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: WALTERS WHOLESALE ELECTRIC CO MEDICAL & DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 4 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $4,083 | | Total amount of fees paid to insurance company | USD $4,014 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $145,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,083 | | Amount paid for insurance broker fees | 4014 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | S4582/77334/176 |
| Policy instance | 3 |
| Insurance contract or identification number | S4582/77334/176 | | Number of Individuals Covered | 384 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $85,553 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $4,296,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85,553 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 2 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $1,152 | | Total amount of fees paid to insurance company | USD $1,185 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $42,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,152 | | Amount paid for insurance broker fees | 1185 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 002828 |
| Policy instance | 1 |
| Insurance contract or identification number | 002828 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $314 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | 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 Carrier | USD $6,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $314 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 1 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $4,081 | | Total amount of fees paid to insurance company | USD $3,837 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,081 | | Amount paid for insurance broker fees | 3837 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 2 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $1,593 | | Total amount of fees paid to insurance company | USD $1,496 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DHMO | | Welfare Benefit Premiums Paid to Carrier | USD $49,299 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,593 | | Amount paid for insurance broker fees | 1496 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 168905 |
| Policy instance | 3 |
| Insurance contract or identification number | 168905 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $87,589 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,293,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,589 | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 002828 |
| Policy instance | 4 |
| Insurance contract or identification number | 002828 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $376 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM (EAP) | | Welfare Benefit Premiums Paid to Carrier | USD $7,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $376 | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 002828 |
| Policy instance | 4 |
| Insurance contract or identification number | 002828 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $372 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM (EAP) | | Welfare Benefit Premiums Paid to Carrier | USD $7,438 | | 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 |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 168905 |
| Policy instance | 3 |
| Insurance contract or identification number | 168905 | | Number of Individuals Covered | 390 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $91,806 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,656,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $91,806 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 2 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $1,405 | | Total amount of fees paid to insurance company | USD $3,028 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DHMO | | Welfare Benefit Premiums Paid to Carrier | USD $56,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,405 | | Amount paid for insurance broker fees | 3028 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 1 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $3,569 | | Total amount of fees paid to insurance company | USD $6,906 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,782 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,569 | | Amount paid for insurance broker fees | 6906 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 1 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $3,931 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,931 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 2 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $1,904 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DHMO | | Welfare Benefit Premiums Paid to Carrier | USD $63,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,904 | | Insurance broker organization code? | 3 |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 168905 |
| Policy instance | 3 |
| Insurance contract or identification number | 168905 | | Number of Individuals Covered | 440 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $87,666 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,418,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,666 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 1 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $7,842 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $130,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,842 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 2 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $3,929 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | DHMO | | Welfare Benefit Premiums Paid to Carrier | USD $65,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,929 | | Insurance broker organization code? | 3 |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 168905 |
| Policy instance | 3 |
| Insurance contract or identification number | 168905 | | Number of Individuals Covered | 446 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $96,766 | | Welfare Benefit Premiums Paid to Carrier | USD $4,703,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $96,766 |
|
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
| Policy contract number | 908010 |
| Policy instance | 4 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $5,668 | | Total amount of fees paid to insurance company | USD $5,730 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,781 | | Amount paid for insurance broker fees | 3831 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 908010 |
| Policy instance | 3 |
| Insurance contract or identification number | 908010 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 0847144-HNO |
| Policy instance | 2 |
| Insurance contract or identification number | 0847144-HNO | | Number of Individuals Covered | 448 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $99,023 | | Welfare Benefit Premiums Paid to Carrier | USD $4,829,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99,023 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0847144 |
| Policy instance | 1 |
| Insurance contract or identification number | 0847144 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $422 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $422 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
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