FCA US LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES
401k plan membership statisitcs for FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES
| Measure | Date | Value |
|---|
| 2013 : FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $0 |
| Total transfer of assets from this plan | 2013-12-31 | $144,680 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $1,284,119 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $1,321,990 |
| Total income from all sources (including contributions) | 2013-12-31 | $26,485,184 |
| Total loss/gain on sale of assets | 2013-12-31 | $0 |
| Total of all expenses incurred | 2013-12-31 | $26,255,007 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $24,591,007 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $26,278,703 |
| Value of total assets at end of year | 2013-12-31 | $773,531 |
| Value of total assets at beginning of year | 2013-12-31 | $725,905 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $1,664,000 |
| Total interest from all sources | 2013-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $30,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $7,844,886 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $773,531 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $696,548 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $43,509 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $51,300 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $230,177 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $-510,588 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $-596,085 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest in master investment trust accounts at end of year | 2013-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2013-12-31 | $29,357 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $7,549,549 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $18,433,817 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $17,041,458 |
| Contract administrator fees | 2013-12-31 | $1,664,000 |
| 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 | 2013-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $1,240,610 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $1,270,690 |
| Did the plan have assets held for investment | 2013-12-31 | 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 | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | PLANTE MORAN PLLC |
| Accountancy firm EIN | 2013-12-31 | 381357971 |
| 2012 : FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $0 |
| Total transfer of assets from this plan | 2012-12-31 | $103,164 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $1,321,990 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $1,580,000 |
| Total income from all sources (including contributions) | 2012-12-31 | $25,544,491 |
| Total loss/gain on sale of assets | 2012-12-31 | $0 |
| Total of all expenses incurred | 2012-12-31 | $25,440,767 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $23,855,139 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $25,383,873 |
| Value of total assets at end of year | 2012-12-31 | $725,905 |
| Value of total assets at beginning of year | 2012-12-31 | $983,355 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,585,628 |
| Total interest from all sources | 2012-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $30,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $7,614,171 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $696,548 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $941,669 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $51,300 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $103,724 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $-596,085 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $-596,645 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in master investment trust accounts at end of year | 2012-12-31 | $29,357 |
| Value of interest in master investment trust accounts at beginning of year | 2012-12-31 | $41,686 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $7,194,317 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $17,769,702 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $16,660,822 |
| Contract administrator fees | 2012-12-31 | $1,585,628 |
| 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 | 2012-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $1,270,690 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $1,580,000 |
| Did the plan have assets held for investment | 2012-12-31 | 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 | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | PLANTE MORAN, PLLC |
| Accountancy firm EIN | 2012-12-31 | 381357971 |
| 2011 : FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $0 |
| Total transfer of assets to this plan | 2011-12-31 | $38,613,813 |
| Total transfer of assets from this plan | 2011-12-31 | $182,877 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $1,580,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $0 |
| Total income from all sources (including contributions) | 2011-12-31 | $21,704,216 |
| Total loss/gain on sale of assets | 2011-12-31 | $0 |
| Total of all expenses incurred | 2011-12-31 | $60,731,797 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $57,970,323 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $21,631,189 |
| Value of total assets at end of year | 2011-12-31 | $983,355 |
| Value of total assets at beginning of year | 2011-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $2,761,474 |
| Total interest from all sources | 2011-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $30,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $8,615,593 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $697,782 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $941,669 |
| Administrative expenses (other) incurred | 2011-12-31 | $540,485 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-39,027,581 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $-596,645 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest in master investment trust accounts at end of year | 2011-12-31 | $41,686 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $7,281,062 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $12,317,814 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $50,689,261 |
| Contract administrator fees | 2011-12-31 | $2,220,989 |
| 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 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $1,580,000 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| 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 | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | PLANTE MORAN, PLLC |
| Accountancy firm EIN | 2011-12-31 | 381357971 |
| 2023: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: FCA US LLC HEALTH CARE BENEFIT PLAN FOR SALARIED REPRESENTED RETIREES 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | First time form 5500 has been submitted | Yes |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| Insurance contract or identification number | 732 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 40150846 |
| Policy instance | 8 |
| Insurance contract or identification number | 40150846 | | Number of Individuals Covered | 5120 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $124,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 2 |
| Insurance contract or identification number | 700 | | Number of Individuals Covered | 1947 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,045,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 3 |
| Insurance contract or identification number | 758 | | Number of Individuals Covered | 2222 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $241,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 4 |
| Insurance contract or identification number | 756 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $77,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 5 |
| Insurance contract or identification number | 728 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 6 |
| Insurance contract or identification number | 748 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| Insurance contract or identification number | 750 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| Insurance contract or identification number | 732 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| Insurance contract or identification number | 640 | | Number of Individuals Covered | 3286 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $119,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 4 |
| Insurance contract or identification number | 758 | | Number of Individuals Covered | 2363 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $255,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 5 |
| Insurance contract or identification number | 756 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $79,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 6 |
| Insurance contract or identification number | 674 | | Number of Individuals Covered | 2283 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $45,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 7 |
| Insurance contract or identification number | 728 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $26,496 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 3 |
| Insurance contract or identification number | 700 | | Number of Individuals Covered | 2182 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,181,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 8 |
| Insurance contract or identification number | 748 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $424 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 9 |
| Insurance contract or identification number | 750 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 4 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 5 |
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 6 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 9 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 3 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 5 |
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 6 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 9 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 10 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 4 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 4 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 3 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 5 |
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 6 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 9 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 10 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 4 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 3 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 6 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 5 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 9 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 10 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 648 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 15 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 14 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 13 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 12 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 642 |
| Policy instance | 3 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 644 |
| Policy instance | 4 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 650 |
| Policy instance | 6 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 7 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 8 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 9 |
| HERITAGE VISION PLANS, INC (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 674 |
| Policy instance | 11 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 726 |
| Policy instance | 10 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 650 |
| Policy instance | 6 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 726 |
| Policy instance | 1 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 4 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 670 |
| Policy instance | 5 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 15 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 14 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 13 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 644 |
| Policy instance | 12 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 11 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 9 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 648 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 642 |
| Policy instance | 10 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 726 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 700 |
| Policy instance | 14 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 13 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 644 |
| Policy instance | 12 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 11 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 642 |
| Policy instance | 10 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 2 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 9 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 648 |
| Policy instance | 8 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 650 |
| Policy instance | 6 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 670 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 4 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 640 |
| Policy instance | 15 |
| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 000111ALL |
| Policy instance | 17 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 648 |
| Policy instance | 16 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 2 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 650 |
| Policy instance | 3 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 599 |
| Policy instance | 4 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | GC0010HA |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 6071 |
| Policy instance | 6 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 8 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 00000 |
| Policy instance | 9 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 670 |
| Policy instance | 11 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 00000 |
| Policy instance | 12 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 00000 |
| Policy instance | 13 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 400 |
| Policy instance | 14 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 851 |
| Policy instance | 15 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 10 |
| BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 ) |
| Policy contract number | 758 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 202 |
| Policy instance | 1 |
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
| Policy contract number | 00000 |
| Policy instance | 1 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 6071 |
| Policy instance | 12 |
| HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 ) |
| Policy contract number | 000111ALL |
| Policy instance | 13 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 14 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | GC0010HA |
| Policy instance | 15 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 0000 |
| Policy instance | 16 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 00000 |
| Policy instance | 8 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 599 |
| Policy instance | 11 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 10 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 650 |
| Policy instance | 9 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 00000 |
| Policy instance | 7 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 00000 |
| Policy instance | 5 |
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 648 |
| Policy instance | 4 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 00000 |
| Policy instance | 3 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 851 |
| Policy instance | 2 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 202 |
| Policy instance | 6 |
