SAN YSIDRO HEALTH CENTER, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN
401k plan membership statisitcs for SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN
Measure | Date | Value |
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2020 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2020 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-04-30 | $73,708 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-04-30 | $73,944 |
Total income from all sources (including contributions) | 2020-04-30 | $12,007,469 |
Total of all expenses incurred | 2020-04-30 | $12,025,709 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-04-30 | $11,926,118 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-04-30 | $12,007,469 |
Value of total assets at end of year | 2020-04-30 | $105,001 |
Value of total assets at beginning of year | 2020-04-30 | $123,477 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-04-30 | $99,591 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-04-30 | No |
Was this plan covered by a fidelity bond | 2020-04-30 | No |
If this is an individual account plan, was there a blackout period | 2020-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2020-04-30 | No |
Contributions received from participants | 2020-04-30 | $2,438,962 |
Income. Received or receivable in cash from other sources (including rollovers) | 2020-04-30 | $21,589 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-04-30 | $600,822 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-04-30 | $73,708 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-04-30 | $73,944 |
Total non interest bearing cash at end of year | 2020-04-30 | $189 |
Total non interest bearing cash at beginning of year | 2020-04-30 | $18,429 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
Value of net income/loss | 2020-04-30 | $-18,240 |
Value of net assets at end of year (total assets less liabilities) | 2020-04-30 | $31,293 |
Value of net assets at beginning of year (total assets less liabilities) | 2020-04-30 | $49,533 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2020-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2020-04-30 | No |
Value of interest in pooled separate accounts at end of year | 2020-04-30 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2020-04-30 | $11,152,417 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2020-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2020-04-30 | No |
Contributions received in cash from employer | 2020-04-30 | $9,546,918 |
Employer contributions (assets) at end of year | 2020-04-30 | $104,812 |
Employer contributions (assets) at beginning of year | 2020-04-30 | $105,048 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-04-30 | $172,879 |
Contract administrator fees | 2020-04-30 | $99,591 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-04-30 | No |
Did the plan have assets held for investment | 2020-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2020-04-30 | Unqualified |
Accountancy firm name | 2020-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2020-04-30 | 043595246 |
2019 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2019 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-04-30 | $73,944 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-04-30 | $111,065 |
Total income from all sources (including contributions) | 2019-04-30 | $10,319,433 |
Total of all expenses incurred | 2019-04-30 | $10,290,364 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-04-30 | $10,199,358 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-04-30 | $10,319,433 |
Value of total assets at end of year | 2019-04-30 | $123,477 |
Value of total assets at beginning of year | 2019-04-30 | $131,529 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-04-30 | $91,006 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-04-30 | No |
Was this plan covered by a fidelity bond | 2019-04-30 | No |
If this is an individual account plan, was there a blackout period | 2019-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2019-04-30 | No |
Contributions received from participants | 2019-04-30 | $2,138,072 |
Income. Received or receivable in cash from other sources (including rollovers) | 2019-04-30 | $47,758 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-04-30 | $608,103 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-04-30 | $73,944 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-04-30 | $111,065 |
Total non interest bearing cash at end of year | 2019-04-30 | $18,429 |
Total non interest bearing cash at beginning of year | 2019-04-30 | $18,615 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
Value of net income/loss | 2019-04-30 | $29,069 |
Value of net assets at end of year (total assets less liabilities) | 2019-04-30 | $49,533 |
Value of net assets at beginning of year (total assets less liabilities) | 2019-04-30 | $20,464 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-04-30 | No |
Value of interest in pooled separate accounts at end of year | 2019-04-30 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2019-04-30 | $9,420,117 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2019-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-04-30 | No |
Contributions received in cash from employer | 2019-04-30 | $8,133,603 |
Employer contributions (assets) at end of year | 2019-04-30 | $105,048 |
Employer contributions (assets) at beginning of year | 2019-04-30 | $112,914 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-04-30 | $171,138 |
Contract administrator fees | 2019-04-30 | $91,006 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-04-30 | No |
Did the plan have assets held for investment | 2019-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2019-04-30 | Unqualified |
Accountancy firm name | 2019-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2019-04-30 | 043595246 |
2018 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2018 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-04-30 | $111,065 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-04-30 | $81,788 |
Total income from all sources (including contributions) | 2018-04-30 | $9,373,392 |
Total of all expenses incurred | 2018-04-30 | $9,371,432 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-04-30 | $9,291,045 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-04-30 | $9,373,392 |
Value of total assets at end of year | 2018-04-30 | $131,529 |
Value of total assets at beginning of year | 2018-04-30 | $100,292 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-04-30 | $80,387 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-04-30 | No |
Was this plan covered by a fidelity bond | 2018-04-30 | No |
If this is an individual account plan, was there a blackout period | 2018-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2018-04-30 | No |
Contributions received from participants | 2018-04-30 | $1,963,974 |
Income. Received or receivable in cash from other sources (including rollovers) | 2018-04-30 | $22,012 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-04-30 | $538,207 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-04-30 | $111,065 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-04-30 | $81,788 |
Total non interest bearing cash at end of year | 2018-04-30 | $18,615 |
Total non interest bearing cash at beginning of year | 2018-04-30 | $18,569 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
Value of net income/loss | 2018-04-30 | $1,960 |
Value of net assets at end of year (total assets less liabilities) | 2018-04-30 | $20,464 |
Value of net assets at beginning of year (total assets less liabilities) | 2018-04-30 | $18,504 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2018-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2018-04-30 | No |
Value of interest in common/collective trusts at end of year | 2018-04-30 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2018-04-30 | $8,576,680 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2018-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2018-04-30 | No |
Contributions received in cash from employer | 2018-04-30 | $7,387,406 |
Employer contributions (assets) at end of year | 2018-04-30 | $112,914 |
Employer contributions (assets) at beginning of year | 2018-04-30 | $81,723 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-04-30 | $176,158 |
Contract administrator fees | 2018-04-30 | $80,387 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-04-30 | No |
Did the plan have assets held for investment | 2018-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2018-04-30 | Unqualified |
Accountancy firm name | 2018-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2018-04-30 | 043595246 |
2017 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2017 401k financial data |
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Total plan liabilities at end of year | 2017-04-30 | $81,788 |
Total plan liabilities at beginning of year | 2017-04-30 | $23,435 |
Total income from all sources | 2017-04-30 | $8,084,268 |
Expenses. Total of all expenses incurred | 2017-04-30 | $8,084,269 |
Benefits paid (including direct rollovers) | 2017-04-30 | $7,997,317 |
Total plan assets at end of year | 2017-04-30 | $100,292 |
Total plan assets at beginning of year | 2017-04-30 | $41,940 |
Total contributions received or receivable from participants | 2017-04-30 | $1,823,446 |
Expenses. Other expenses not covered elsewhere | 2017-04-30 | $86,952 |
Contributions received from other sources (not participants or employers) | 2017-04-30 | $15,427 |
Net income (gross income less expenses) | 2017-04-30 | $-1 |
Net plan assets at end of year (total assets less liabilities) | 2017-04-30 | $18,504 |
Net plan assets at beginning of year (total assets less liabilities) | 2017-04-30 | $18,505 |
Total contributions received or receivable from employer(s) | 2017-04-30 | $6,245,395 |
2016 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2016 401k financial data |
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Total plan liabilities at end of year | 2016-04-30 | $23,435 |
Total plan liabilities at beginning of year | 2016-04-30 | $55,493 |
Total income from all sources | 2016-04-30 | $7,072,821 |
Expenses. Total of all expenses incurred | 2016-04-30 | $7,086,114 |
Benefits paid (including direct rollovers) | 2016-04-30 | $7,000,385 |
Total plan assets at end of year | 2016-04-30 | $41,940 |
Total plan assets at beginning of year | 2016-04-30 | $87,291 |
Total contributions received or receivable from participants | 2016-04-30 | $1,550,811 |
Expenses. Other expenses not covered elsewhere | 2016-04-30 | $85,729 |
Contributions received from other sources (not participants or employers) | 2016-04-30 | $7,174 |
Net income (gross income less expenses) | 2016-04-30 | $-13,293 |
Net plan assets at end of year (total assets less liabilities) | 2016-04-30 | $18,505 |
Net plan assets at beginning of year (total assets less liabilities) | 2016-04-30 | $31,798 |
Total contributions received or receivable from employer(s) | 2016-04-30 | $5,514,836 |
2015 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2015 401k financial data |
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Total plan liabilities at end of year | 2015-04-30 | $55,493 |
Total plan liabilities at beginning of year | 2015-04-30 | $23,619 |
Total income from all sources | 2015-04-30 | $6,341,492 |
Expenses. Total of all expenses incurred | 2015-04-30 | $6,355,050 |
Benefits paid (including direct rollovers) | 2015-04-30 | $6,261,887 |
Total plan assets at end of year | 2015-04-30 | $87,291 |
Total plan assets at beginning of year | 2015-04-30 | $68,975 |
Total contributions received or receivable from participants | 2015-04-30 | $1,386,860 |
Expenses. Other expenses not covered elsewhere | 2015-04-30 | $93,163 |
Contributions received from other sources (not participants or employers) | 2015-04-30 | $15,141 |
Net income (gross income less expenses) | 2015-04-30 | $-13,558 |
Net plan assets at end of year (total assets less liabilities) | 2015-04-30 | $31,798 |
Net plan assets at beginning of year (total assets less liabilities) | 2015-04-30 | $45,356 |
Total contributions received or receivable from employer(s) | 2015-04-30 | $4,939,491 |
2014 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2014 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-04-30 | $23,619 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-04-30 | $17,434 |
Total income from all sources (including contributions) | 2014-04-30 | $5,597,683 |
Total of all expenses incurred | 2014-04-30 | $5,590,196 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-04-30 | $5,492,754 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-04-30 | $5,597,683 |
Value of total assets at end of year | 2014-04-30 | $68,975 |
Value of total assets at beginning of year | 2014-04-30 | $55,303 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-04-30 | $97,442 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-04-30 | No |
Was this plan covered by a fidelity bond | 2014-04-30 | No |
If this is an individual account plan, was there a blackout period | 2014-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2014-04-30 | No |
Contributions received from participants | 2014-04-30 | $1,280,106 |
Income. Received or receivable in cash from other sources (including rollovers) | 2014-04-30 | $30,763 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-04-30 | $646,631 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-04-30 | $23,619 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-04-30 | $17,434 |
Total non interest bearing cash at end of year | 2014-04-30 | $18,473 |
Total non interest bearing cash at beginning of year | 2014-04-30 | $9,773 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-04-30 | No |
Value of net income/loss | 2014-04-30 | $7,487 |
Value of net assets at end of year (total assets less liabilities) | 2014-04-30 | $45,356 |
Value of net assets at beginning of year (total assets less liabilities) | 2014-04-30 | $37,869 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2014-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2014-04-30 | No |
Value of interest in common/collective trusts at end of year | 2014-04-30 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2014-04-30 | $4,733,689 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2014-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2014-04-30 | No |
Contributions received in cash from employer | 2014-04-30 | $4,286,814 |
Employer contributions (assets) at end of year | 2014-04-30 | $50,502 |
Employer contributions (assets) at beginning of year | 2014-04-30 | $45,530 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-04-30 | $112,434 |
Contract administrator fees | 2014-04-30 | $97,442 |
Did the plan have assets held for investment | 2014-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2014-04-30 | Unqualified |
Accountancy firm name | 2014-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2014-04-30 | 043595246 |
2013 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-04-30 | $17,434 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-04-30 | $16,649 |
Total income from all sources (including contributions) | 2013-04-30 | $5,062,166 |
Total of all expenses incurred | 2013-04-30 | $5,035,507 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-04-30 | $4,944,854 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-04-30 | $5,062,166 |
Value of total assets at end of year | 2013-04-30 | $55,303 |
Value of total assets at beginning of year | 2013-04-30 | $27,859 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-04-30 | $90,653 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-04-30 | No |
Was this plan covered by a fidelity bond | 2013-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2013-04-30 | No |
Contributions received from participants | 2013-04-30 | $1,141,641 |
Income. Received or receivable in cash from other sources (including rollovers) | 2013-04-30 | $31,525 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-04-30 | $535,025 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-04-30 | $17,434 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-04-30 | $16,649 |
Total non interest bearing cash at end of year | 2013-04-30 | $9,773 |
Total non interest bearing cash at beginning of year | 2013-04-30 | $1,310 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
Value of net income/loss | 2013-04-30 | $26,659 |
Value of net assets at end of year (total assets less liabilities) | 2013-04-30 | $37,869 |
Value of net assets at beginning of year (total assets less liabilities) | 2013-04-30 | $11,210 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2013-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2013-04-30 | No |
Value of interest in common/collective trusts at end of year | 2013-04-30 | $0 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2013-04-30 | $4,315,579 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2013-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2013-04-30 | No |
Contributions received in cash from employer | 2013-04-30 | $3,889,000 |
Employer contributions (assets) at end of year | 2013-04-30 | $45,530 |
Employer contributions (assets) at beginning of year | 2013-04-30 | $26,549 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-04-30 | $94,250 |
Contract administrator fees | 2013-04-30 | $90,653 |
Did the plan have assets held for investment | 2013-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2013-04-30 | Unqualified |
Accountancy firm name | 2013-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2013-04-30 | 043595246 |
2012 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data |
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Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-04-30 | $16,649 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-04-30 | $13,545 |
Total income from all sources (including contributions) | 2012-04-30 | $4,335,299 |
Total of all expenses incurred | 2012-04-30 | $4,351,979 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-04-30 | $4,270,774 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-04-30 | $4,335,299 |
Value of total assets at end of year | 2012-04-30 | $27,859 |
Value of total assets at beginning of year | 2012-04-30 | $41,435 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-04-30 | $81,205 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-04-30 | No |
Was this plan covered by a fidelity bond | 2012-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2012-04-30 | No |
Contributions received from participants | 2012-04-30 | $1,005,703 |
Income. Received or receivable in cash from other sources (including rollovers) | 2012-04-30 | $10,239 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-04-30 | $502,748 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-04-30 | $16,649 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-04-30 | $13,545 |
Total non interest bearing cash at end of year | 2012-04-30 | $1,310 |
Total non interest bearing cash at beginning of year | 2012-04-30 | $3,236 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
Value of net income/loss | 2012-04-30 | $-16,680 |
Value of net assets at end of year (total assets less liabilities) | 2012-04-30 | $11,210 |
Value of net assets at beginning of year (total assets less liabilities) | 2012-04-30 | $27,890 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-04-30 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2012-04-30 | $3,696,333 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2012-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2012-04-30 | No |
Contributions received in cash from employer | 2012-04-30 | $3,319,357 |
Employer contributions (assets) at end of year | 2012-04-30 | $26,549 |
Employer contributions (assets) at beginning of year | 2012-04-30 | $38,199 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-04-30 | $71,693 |
Contract administrator fees | 2012-04-30 | $81,205 |
Did the plan have assets held for investment | 2012-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2012-04-30 | Unqualified |
Accountancy firm name | 2012-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2012-04-30 | 043595246 |
2011 : SAN YSIDRO HEALTH EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data |
---|
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-04-30 | $13,545 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-04-30 | $10,721 |
Total income from all sources (including contributions) | 2011-04-30 | $3,705,639 |
Total of all expenses incurred | 2011-04-30 | $3,684,484 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-04-30 | $3,588,038 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-04-30 | $3,705,639 |
Value of total assets at end of year | 2011-04-30 | $41,435 |
Value of total assets at beginning of year | 2011-04-30 | $17,456 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-04-30 | $96,446 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-04-30 | No |
Was this plan covered by a fidelity bond | 2011-04-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2011-04-30 | No |
Contributions received from participants | 2011-04-30 | $957,764 |
Income. Received or receivable in cash from other sources (including rollovers) | 2011-04-30 | $25,488 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-04-30 | $462,231 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-04-30 | $13,545 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-04-30 | $10,721 |
Administrative expenses (other) incurred | 2011-04-30 | $9,954 |
Total non interest bearing cash at end of year | 2011-04-30 | $3,236 |
Total non interest bearing cash at beginning of year | 2011-04-30 | $6,735 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-04-30 | No |
Value of net income/loss | 2011-04-30 | $21,155 |
Value of net assets at end of year (total assets less liabilities) | 2011-04-30 | $27,890 |
Value of net assets at beginning of year (total assets less liabilities) | 2011-04-30 | $6,735 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-04-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-04-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-04-30 | No |
Expenses. Payments to insurance carriers foe the provision of benefits | 2011-04-30 | $3,035,237 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-04-30 | No |
Was there a failure to transmit to the plan any participant contributions | 2011-04-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2011-04-30 | No |
Contributions received in cash from employer | 2011-04-30 | $2,722,387 |
Employer contributions (assets) at end of year | 2011-04-30 | $38,199 |
Employer contributions (assets) at beginning of year | 2011-04-30 | $10,721 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-04-30 | $90,570 |
Contract administrator fees | 2011-04-30 | $86,492 |
Did the plan have assets held for investment | 2011-04-30 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-04-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-04-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-04-30 | No |
Opinion of an independent qualified public accountant for this plan | 2011-04-30 | Unqualified |
Accountancy firm name | 2011-04-30 | STACK AND ASSOCIATES, CPAS |
Accountancy firm EIN | 2011-04-30 | 043595246 |
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 36 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $1,217 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $6,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,217 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL159226 |
Policy instance | 8 |
Insurance contract or identification number | GL159226 | Number of Individuals Covered | 2115 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $56,506 | Total amount of fees paid to insurance company | USD $9,170 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $706,327 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $56,506 | Amount paid for insurance broker fees | 9170 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 1541069 |
Policy instance | 7 |
Insurance contract or identification number | 1541069 | Number of Individuals Covered | 2501 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $4,246 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $38,786 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,246 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | NS0025-000 |
Policy instance | 6 |
Insurance contract or identification number | NS0025-000 | Number of Individuals Covered | 1676 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CHIROPRACTIC/ACUPUNTURE | Welfare Benefit Premiums Paid to Carrier | USD $47,940 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 5 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 3444 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $22,170 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $189,895 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,170 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 3 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 384 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $44,314 | Total amount of fees paid to insurance company | USD $1,097 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $477,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,311 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 2 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1272 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $64,867 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,162,224 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,867 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 ) |
Policy contract number | 1001876 |
Policy instance | 1 |
Insurance contract or identification number | 1001876 | Number of Individuals Covered | 2575 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,346,742 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 2 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1158 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $60,905 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,030,159 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $60,905 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 ) |
Policy contract number | 1001876 |
Policy instance | 1 |
Insurance contract or identification number | 1001876 | Number of Individuals Covered | 2186 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,137,009 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 3 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 397 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $35,080 | Total amount of fees paid to insurance company | USD $594 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $411,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,749 | Amount paid for insurance broker fees | 265 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 5 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 3094 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $16,962 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $187,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,962 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NS0025-000 |
Policy instance | 6 |
Insurance contract or identification number | NS0025-000 | Number of Individuals Covered | 1452 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CHIROPRACTIC/ACUPUNTURE | Welfare Benefit Premiums Paid to Carrier | USD $38,149 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL159226 |
Policy instance | 7 |
Insurance contract or identification number | GL159226 | Number of Individuals Covered | 1878 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $40,276 | Total amount of fees paid to insurance company | USD $8,751 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $503,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,276 | Amount paid for insurance broker fees | 8751 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 25 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $744 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $4,179 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $744 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 2 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1191 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $53,499 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $178,300 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $53,499 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 3 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 427 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $70,733 | Total amount of fees paid to insurance company | USD $2,870 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $264,744 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,843 | Amount paid for insurance broker fees | 1019 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 ) |
Policy contract number | 1001876 |
Policy instance | 1 |
Insurance contract or identification number | 1001876 | Number of Individuals Covered | 1327 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,498,004 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL159226 |
Policy instance | 8 |
Insurance contract or identification number | GL159226 | Number of Individuals Covered | 1563 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $37,325 | Total amount of fees paid to insurance company | USD $7,063 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $466,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,325 | Amount paid for insurance broker fees | 7063 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 5 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 2741 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $15,897 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $160,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,897 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | SYHC |
Policy instance | 7 |
Insurance contract or identification number | SYHC | Number of Individuals Covered | 1333 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | NS0025-000 |
Policy instance | 6 |
Insurance contract or identification number | NS0025-000 | Number of Individuals Covered | 1173 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CHIROPRACTIC/ACUPUNTURE | Welfare Benefit Premiums Paid to Carrier | USD $30,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 25 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $916 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $4,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $916 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1361 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,754,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 445 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $68,836 | Total amount of fees paid to insurance company | USD $3,142 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $522,778 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,527 | Amount paid for insurance broker fees | 580 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 0009136625-B |
Policy instance | 3 |
Insurance contract or identification number | 0009136625-B | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $75 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $75 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 159226 |
Policy instance | 4 |
Insurance contract or identification number | GL 159226 | Number of Individuals Covered | 1268 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $9,220 | Total amount of fees paid to insurance company | USD $2,281 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,220 | Amount paid for insurance broker fees | 2281 | Additional information about fees paid to insurance broker | ADMINISTRATIVE | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129904 |
Policy instance | 5 |
Insurance contract or identification number | LTD 129904 | Number of Individuals Covered | 1268 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $18,286 | Total amount of fees paid to insurance company | USD $4,538 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $228,572 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,286 | Amount paid for insurance broker fees | 4538 | Additional information about fees paid to insurance broker | ADMINISTRATIVE | Insurance broker organization code? | 3 |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | NS0025*000 |
Policy instance | 10 |
Insurance contract or identification number | NS0025*000 | Number of Individuals Covered | 993 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SHARP HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 90611 ) |
Policy contract number | 1001876 |
Policy instance | 1 |
Insurance contract or identification number | 1001876 | Number of Individuals Covered | 1568 | Total amount of commissions paid to insurance broker | USD $178,613 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,953,781 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $178,613 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 9 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 2410 | Total amount of commissions paid to insurance broker | USD $14,584 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $147,688 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,584 | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 2 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Other welfare benefits provided | PREPAID MEDICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 7 |
Insurance contract or identification number | 324 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $50,112 | Other welfare benefits provided | PREPAID MEDICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Number of Individuals Covered | 1123 | Commission paid to Insurance Broker | USD $50,112 | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 6 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $193 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Welfare Benefit Premiums Paid to Carrier | USD $4,447 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $193 | Insurance broker organization code? | 4 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $725 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,045 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $725 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 0009136625-B |
Policy instance | 3 |
Insurance contract or identification number | 0009136625-B | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $75 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $75 | Insurance broker organization code? | 3 | Number of Individuals Covered | 1025 | Total amount of fees paid to insurance company | USD $0 | Amount paid for insurance broker fees | 0 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 159226 |
Policy instance | 4 |
Insurance contract or identification number | GL 159226 | Number of Individuals Covered | 1194 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $6,825 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $85,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,825 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129904 |
Policy instance | 5 |
Insurance contract or identification number | LTD 129904 | Number of Individuals Covered | 1194 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $13,562 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $169,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,562 | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 6 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $725 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Welfare Benefit Premiums Paid to Carrier | USD $3,045 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $725 | Insurance broker organization code? | 4 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 7 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1029 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $42,185 | Other welfare benefits provided | PREPAID MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $1,406,158 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,185 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD129904 |
Policy instance | 5 |
Insurance contract or identification number | LTD129904 | Number of Individuals Covered | 1194 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $13,562 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $169,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,562 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 4 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Other welfare benefits provided | PREPAID MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,014 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL159226 |
Policy instance | 6 |
Insurance contract or identification number | GL159226 | Number of Individuals Covered | 1194 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $6,825 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $85,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,825 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 7 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 4 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,014 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 9 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 2024 | Total amount of commissions paid to insurance broker | USD $11,449 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,383 | Insurance broker organization code? | 3 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of fees paid to insurance company | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | BONUS |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1361 | Total amount of commissions paid to insurance broker | USD $142,650 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,754,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $142,650 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 405 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $64,841 | Total amount of fees paid to insurance company | USD $5,731 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $421,604 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,124 | Amount paid for insurance broker fees | 2361 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 8 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1029 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $42,185 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,406,158 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,185 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1361 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $142,650 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,754,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $142,650 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 405 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $64,841 | Total amount of fees paid to insurance company | USD $5,731 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $421,604 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,124 | Amount paid for insurance broker fees | 2361 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 8 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1026 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $47,318 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,577,280 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $47,318 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1177 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $4,083 | Total amount of fees paid to insurance company | USD $1,030 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $4,083 | Amount paid for insurance broker fees | 1030 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $782 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,213 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $753 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 7 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 2 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,629 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1257 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $139,891 | Total amount of fees paid to insurance company | USD $11,608 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,674,441 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $139,891 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 397 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $117,693 | Total amount of fees paid to insurance company | USD $23,468 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $414,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,003 | Amount paid for insurance broker fees | 12556 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 7 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1026 | Total amount of commissions paid to insurance broker | USD $47,318 | Other welfare benefits provided | PREPAID MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $1,577,280 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1257 | Total amount of commissions paid to insurance broker | USD $139,891 | Total amount of fees paid to insurance company | USD $11,608 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,674,441 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 2 | Welfare Benefit Premiums Paid to Carrier | USD $5,629 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10000831001 |
Policy instance | 9 |
Insurance contract or identification number | 10000831001 | Number of Individuals Covered | 1944 | Total amount of commissions paid to insurance broker | USD $12,034 | Welfare Benefit Premiums Paid to Carrier | USD $120,390 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Commission paid to Insurance Broker | USD $12,034 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 6 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Total amount of commissions paid to insurance broker | USD $782 | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | Welfare Benefit Premiums Paid to Carrier | USD $3,213 | 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 number | 649688 |
Policy instance | 5 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1177 | Total amount of commissions paid to insurance broker | USD $6,048 | Total amount of fees paid to insurance company | USD $2,113 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Commission paid to Insurance Broker | USD $6,048 | Amount paid for insurance broker fees | 2113 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 4 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1177 | Total amount of commissions paid to insurance broker | USD $4,083 | Total amount of fees paid to insurance company | USD $1,030 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | 0009136625-B |
Policy instance | 3 |
Insurance contract or identification number | 0009136625-B | Number of Individuals Covered | 2 | Total amount of commissions paid to insurance broker | USD $101 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of fees paid to insurance company | USD $0 | Commission paid to Insurance Broker | USD $101 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 397 | Total amount of commissions paid to insurance broker | USD $117,693 | Total amount of fees paid to insurance company | USD $23,468 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $414,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1136 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $169,663 | Total amount of fees paid to insurance company | USD $12,757 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,671,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $140,477 | Amount paid for insurance broker fees | 12757 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 17 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $1,051 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,486 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $942 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 5 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1122 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $5,927 | Total amount of fees paid to insurance company | USD $5,801 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,927 | Amount paid for insurance broker fees | 5801 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1122 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $3,930 | Total amount of fees paid to insurance company | USD $3,181 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $3,930 | Amount paid for insurance broker fees | 3181 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 7 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 11 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,939 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 8 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 1014 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $68,901 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,378,035 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $68,901 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 267 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $24,665 | Total amount of fees paid to insurance company | USD $3,199 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $185,753 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,076 | Amount paid for insurance broker fees | 1957 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 3 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 212 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $17,453 | Total amount of fees paid to insurance company | USD $6,391 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $97,151 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,366 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | CLAIMS ADMINISTRATIVE SERVICES |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 1000083 |
Policy instance | 9 |
Insurance contract or identification number | 1000083 | Number of Individuals Covered | 1823 | Insurance policy start date | 2016-05-01 | Insurance policy end date | 2017-04-30 | Total amount of commissions paid to insurance broker | USD $10,424 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $114,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,424 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1011 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $157,125 | Total amount of fees paid to insurance company | USD $1,829 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $157,125 | Amount paid for insurance broker fees | 1829 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 241 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $12,548 | Total amount of fees paid to insurance company | USD $1,357 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $172,579 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,746 | Amount paid for insurance broker fees | 1243 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1019 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $4,387 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $4,387 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 7 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 3 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,816 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 8 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 948 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $62,572 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,251,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,572 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 3 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 187 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $23,226 | Total amount of fees paid to insurance company | USD $6,140 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $100,723 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,537 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4331 | Additional information about fees paid to insurance broker | CLAIMS ADMINISTRATIVE SERVICES | Insurance broker name | COBB BENEFITS GROUP LLC |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 21 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $927 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $100 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 1011 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $157,125 | Total amount of fees paid to insurance company | USD $1,829 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $157,125 | Amount paid for insurance broker fees | 1829 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | BARNEY & BARNEY LLC |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 6 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 21 | Total amount of commissions paid to insurance broker | USD $927 | Other welfare benefits provided | PREPAID LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $786 | Insurance broker organization code? | 4 | Insurance broker name | JAZMIN S STEELE |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 5 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1019 | Total amount of commissions paid to insurance broker | USD $6,993 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,993 | Insurance broker organization code? | 3 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of fees paid to insurance company | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker name | MARSH & MCLENNAN AGENCY INC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 4 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 1019 | Total amount of commissions paid to insurance broker | USD $4,387 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,387 | Insurance broker organization code? | 3 | Insurance broker name | MARSH AND MCLENNAN AGENCY LLC |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 7 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 948 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $62,572 | Other welfare benefits provided | PREPAID MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $1,251,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,572 | Insurance broker name | BARNEY AND BARNEY |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 241 | Total amount of commissions paid to insurance broker | USD $12,598 | Total amount of fees paid to insurance company | USD $1,357 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $172,579 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,746 | Amount paid for insurance broker fees | 1243 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | CHRISTINA D POLK INC. |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 3 | Welfare Benefit Premiums Paid to Carrier | USD $4,816 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 1000083 |
Policy instance | 9 |
Insurance contract or identification number | 1000083 | Number of Individuals Covered | 1650 | Total amount of commissions paid to insurance broker | USD $9,221 | Welfare Benefit Premiums Paid to Carrier | USD $92,213 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,221 | Insurance broker organization code? | 3 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Amount paid for insurance broker fees | 0 | Insurance broker name | MARSH & MCLELLAN AGENCY |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 922 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $3,818 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $3,818 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 860 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $126,766 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,699,099 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $116,693 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 266 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $13,591 | Total amount of fees paid to insurance company | USD $834 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $203,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,108 | Amount paid for insurance broker fees | 601 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 4 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 12 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $216 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $164 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 7 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 3 | Other welfare benefits provided | PREPAID MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $3,568 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 860 | Total amount of commissions paid to insurance broker | USD $126,766 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,699,099 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $116,693 | Insurance broker organization code? | 3 | Insurance broker name | BARNEY & BARNEY LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 4 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 922 | Total amount of commissions paid to insurance broker | USD $3,818 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,818 | Insurance broker organization code? | 3 | Insurance broker name | MARSH & MCLENNAN AGENCY INC |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 3 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 194 | Total amount of commissions paid to insurance broker | USD $25,165 | Total amount of fees paid to insurance company | USD $5,785 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,818 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,630 | Amount paid for insurance broker fees | 228 | Additional information about fees paid to insurance broker | MARKETING FEE | Insurance broker organization code? | 3 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Insurance broker name | COBB BENEFITS GROUP LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 5 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 922 | Total amount of commissions paid to insurance broker | USD $5,430 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,430 | Insurance broker organization code? | 3 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of fees paid to insurance company | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 6 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 12 | Total amount of commissions paid to insurance broker | USD $216 | Other welfare benefits provided | PREPAID LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $3,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $164 | Insurance broker organization code? | 4 | Insurance broker name | ANNETTE E WHITE INSURNACE SERV |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 266 | Total amount of commissions paid to insurance broker | USD $13,591 | Total amount of fees paid to insurance company | USD $834 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $203,118 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,108 | Amount paid for insurance broker fees | 601 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL FAHEY III |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 7 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 11 | Total amount of commissions paid to insurance broker | USD $258 | Other welfare benefits provided | PREPAID LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $2,837 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $202 | Insurance broker organization code? | 4 | Insurance broker name | ANNETTE E WHITE INSURNACE SERV |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 3 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 723 | Total amount of commissions paid to insurance broker | USD $61,794 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,794 | Insurance broker organization code? | 3 | Insurance broker name | BARNEY & BARNEY |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 4 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 227 | Total amount of commissions paid to insurance broker | USD $12,526 | Total amount of fees paid to insurance company | USD $17,969 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 11867 | Additional information about fees paid to insurance broker | MARKETING FEE | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $8,514 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Welfare Benefit Premiums Paid to Carrier | USD $105,217 | Insurance broker name | BARNEY & BARNEY LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 5 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 794 | Total amount of commissions paid to insurance broker | USD $3,605 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,200 | Insurance broker organization code? | 3 | Insurance broker name | BARNEY & BARNEY LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 794 | Total amount of commissions paid to insurance broker | USD $5,369 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,023 | Insurance broker organization code? | 3 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of fees paid to insurance company | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker name | BARNEY & BARNEY |
|
SIMNSA (National Association of Insurance Commissioners NAIC id number: 62146 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 5 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,415 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 9324 |
Policy instance | 8 |
Insurance contract or identification number | 9324 | Number of Individuals Covered | 5 | Other welfare benefits provided | PREPAID MEDICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 1 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 712 | Total amount of commissions paid to insurance broker | USD $115,693 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $86,535 | Insurance broker organization code? | 3 | Insurance broker name | BARNEY & BARNEY LLC |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 279 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $17,913 | Total amount of fees paid to insurance company | USD $1,687 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $190,191 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,493 | Amount paid for insurance broker fees | 875 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 712 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $115,693 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,311,427 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $86,535 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
SIMNSA (National Association of Insurance Commissioners NAIC id number: 62146 ) |
Policy contract number | 324 |
Policy instance | 3 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 723 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $61,794 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $882,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,794 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 5 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 11 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $258 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $2,837 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $202 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 7 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 794 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $3,605 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $3,200 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 279 | Total amount of commissions paid to insurance broker | USD $17,913 | Total amount of fees paid to insurance company | USD $1,687 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,493 | Amount paid for insurance broker fees | 875 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL FAHEY III |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 7 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 775 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $4,972 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL 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 Broker | USD $4,972 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 7 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 671 | Total amount of commissions paid to insurance broker | USD $108,008 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $108,008 | Insurance broker organization code? | 3 | Insurance broker name | KINGSROAD FINANCIAL INSURANCE |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 6 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 334 | Total amount of commissions paid to insurance broker | USD $66,144 | Total amount of fees paid to insurance company | USD $5,932 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker name | KINGSROAD FINANCIAL INSURANCE SERV |
|
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 5 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 676 | Total amount of commissions paid to insurance broker | USD $63,240 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63,240 | Insurance broker organization code? | 3 | Insurance broker name | KINGSROAD FINANCIAL INSURANCE |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 6 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 775 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $8,170 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,170 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 5 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 10 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $363 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $2,058 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $151 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 |
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SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 3 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 676 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $63,240 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $903,428 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63,240 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 2 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 671 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $108,008 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,881,684 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $108,008 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 334 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $66,144 | Total amount of fees paid to insurance company | USD $5,932 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $229,545 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,197 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 2 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 775 | Total amount of commissions paid to insurance broker | USD $8,170 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,170 | Insurance broker name | KINGSROAD FINANCIAL INSURANCE SRVCS |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649688 |
Policy instance | 3 |
Insurance contract or identification number | 649688 | Number of Individuals Covered | 775 | Total amount of commissions paid to insurance broker | USD $4,972 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,972 | Insurance broker organization code? | 3 | Insurance broker name | KINGSROAD FINANCIAL INSURANCE SERV |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 4 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 241 | Total amount of commissions paid to insurance broker | USD $15,050 | Total amount of fees paid to insurance company | USD $20,868 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 743 | Additional information about fees paid to insurance broker | MARKETING FEE | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $2,051 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Welfare Benefit Premiums Paid to Carrier | USD $112,400 | Insurance broker name | SCOTT CASTEEL |
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PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 102507 |
Policy instance | 1 |
Insurance contract or identification number | 102507 | Number of Individuals Covered | 10 | Total amount of commissions paid to insurance broker | USD $363 | Other welfare benefits provided | PREPAID LEGAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $63 | Insurance broker organization code? | 4 | Insurance broker name | DAVID QUACKENBUSH |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 5 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 249 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $62,478 | Total amount of fees paid to insurance company | USD $11,244 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $114,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,517 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | CLAIMS ADINISTRATIVE SERVICES |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7008385 |
Policy instance | 1 |
Insurance contract or identification number | 7008385 | Number of Individuals Covered | 249 | Total amount of commissions paid to insurance broker | USD $62,478 | Total amount of fees paid to insurance company | USD $11,244 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 2 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 634 | Total amount of commissions paid to insurance broker | USD $51,345 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 5 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 584 | Total amount of commissions paid to insurance broker | USD $95,552 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 091336 |
Policy instance | 4 |
Insurance contract or identification number | 091336 | Number of Individuals Covered | 703 | Total amount of commissions paid to insurance broker | USD $9,281 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 3 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 268 | Total amount of commissions paid to insurance broker | USD $47,864 | Total amount of fees paid to insurance company | USD $4,800 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 268 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $47,864 | Total amount of fees paid to insurance company | USD $4,800 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $182,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,440 | Amount paid for insurance broker fees | 2556 | Additional information about fees paid to insurance broker | PROFIT SHARING FEE | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 091336 |
Policy instance | 2 |
Insurance contract or identification number | 091336 | Number of Individuals Covered | 703 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $9,281 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $182,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,281 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 3 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 584 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $95,552 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,470,528 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $95,552 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 4 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 634 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $51,345 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $733,497 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $51,345 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 4 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 540 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $38,074 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $543,915 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $38,074 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 091336 |
Policy instance | 2 |
Insurance contract or identification number | 091336 | Number of Individuals Covered | 632 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $9,135 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,145 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,135 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 583 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $67,390 | Total amount of fees paid to insurance company | USD $4,071 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $309,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,723 | Amount paid for insurance broker fees | 1664 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 3 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 535 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $62,398 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,024,332 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,398 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 324 |
Policy instance | 1 |
Insurance contract or identification number | 324 | Number of Individuals Covered | 540 | Total amount of commissions paid to insurance broker | USD $38,074 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 2 |
Insurance contract or identification number | E3200706 | Total amount of commissions paid to insurance broker | USD $67,390 | Total amount of fees paid to insurance company | USD $4,071 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | 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 | 091336 |
Policy instance | 3 |
Insurance contract or identification number | 091336 | Number of Individuals Covered | 632 | Total amount of commissions paid to insurance broker | USD $9,135 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 4 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 535 | Total amount of commissions paid to insurance broker | USD $62,398 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 228316 |
Policy instance | 3 |
Insurance contract or identification number | 228316 | Number of Individuals Covered | 534 | Insurance policy start date | 2009-05-01 | Insurance policy end date | 2010-04-30 | Total amount of commissions paid to insurance broker | USD $64,125 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,857,986 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,125 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3200706 |
Policy instance | 1 |
Insurance contract or identification number | E3200706 | Number of Individuals Covered | 584 | Insurance policy start date | 2009-05-01 | Insurance policy end date | 2010-04-30 | Total amount of commissions paid to insurance broker | USD $80,247 | Total amount of fees paid to insurance company | USD $14,395 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $261,940 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $22,081 | Amount paid for insurance broker fees | 6685 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 091336 |
Policy instance | 2 |
Insurance contract or identification number | 091336 | Number of Individuals Covered | 602 | Insurance policy start date | 2009-05-01 | Insurance policy end date | 2010-04-30 | Total amount of commissions paid to insurance broker | USD $10,314 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $192,210 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,314 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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