EMPLOYERS RESOURCE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYERS RESOURCE WRAP BENEFIT PLAN
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 8 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 332 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $12,791 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $193,234 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,791 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 932980 |
Policy instance | 10 |
Insurance contract or identification number | 932980 | Number of Individuals Covered | 12 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $610 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,545 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $610 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 931379 |
Policy instance | 9 |
Insurance contract or identification number | 931379 | Number of Individuals Covered | 27 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $777 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,496 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $777 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 916624 |
Policy instance | 6 |
Insurance contract or identification number | 916624 | Number of Individuals Covered | 32 | Insurance policy start date | 2019-09-01 | Insurance policy end date | 2020-08-31 | Total amount of commissions paid to insurance broker | USD $1,750 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,704 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,750 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 914892 |
Policy instance | 5 |
Insurance contract or identification number | 914892 | Number of Individuals Covered | 30 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $2,616 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,616 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 235493 |
Policy instance | 4 |
Insurance contract or identification number | 235493 | Number of Individuals Covered | 11 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $7,133 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,902 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,133 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 3 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 13 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-06-01 | Total amount of commissions paid to insurance broker | USD $885 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $885 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 341990 |
Policy instance | 2 |
Insurance contract or identification number | 341990 | Number of Individuals Covered | 21 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $9,673 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $120,079 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,696 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 1 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 15 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,853 | Total amount of fees paid to insurance company | USD $159 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,139 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $628 | Amount paid for insurance broker fees | 85 | Insurance broker organization code? | 3 |
|
CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 ) |
Policy contract number | 898641 |
Policy instance | 11 |
Insurance contract or identification number | 898641 | Number of Individuals Covered | 10 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $864 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,597 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $511 |
|
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 612174 |
Policy instance | 7 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 62 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $1,571 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,436 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,571 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 931379 |
Policy instance | 10 |
Insurance contract or identification number | 931379 | Number of Individuals Covered | 28 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $73 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $511 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $73 | Insurance broker organization code? | 3 |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 9 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 359 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $10,622 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $163,022 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,622 | Insurance broker organization code? | 3 |
|
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 612174 |
Policy instance | 8 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 81 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $1,229 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,229 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 916624 |
Policy instance | 7 |
Insurance contract or identification number | 916624 | Number of Individuals Covered | 37 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2019-08-31 | Total amount of commissions paid to insurance broker | USD $1,802 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,013 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,802 | Insurance broker organization code? | 3 |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 914892 |
Policy instance | 6 |
Insurance contract or identification number | 914892 | Number of Individuals Covered | 17 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $3,640 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,640 | Insurance broker organization code? | 3 |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 235493 |
Policy instance | 5 |
Insurance contract or identification number | 235493 | Number of Individuals Covered | 12 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $6,718 | Total amount of fees paid to insurance company | USD $3,360 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,977 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,718 | Amount paid for insurance broker fees | 3360 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 4 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 15 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-06-01 | Total amount of commissions paid to insurance broker | USD $3,280 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,280 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 341990 |
Policy instance | 3 |
Insurance contract or identification number | 341990 | Number of Individuals Covered | 20 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $10,084 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $130,274 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,083 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 9 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-04-01 | Total amount of commissions paid to insurance broker | USD $637 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,047 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $637 | Insurance broker organization code? | 3 |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 15 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $1,535 | Total amount of fees paid to insurance company | USD $96 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $512 | Amount paid for insurance broker fees | 41 | Insurance broker organization code? | 3 |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 7 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 319 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $10,653 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $191,756 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,653 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 235493 |
Policy instance | 6 |
Insurance contract or identification number | 235493 | Number of Individuals Covered | 10 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $8,494 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $80,894 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,663 | Insurance broker organization code? | 3 | Insurance broker name | WORD & BROWN INSURANCE ADMINIS |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 5 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 23 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $3,545 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,626 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,545 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 341990 |
Policy instance | 4 |
Insurance contract or identification number | 341990 | Number of Individuals Covered | 21 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $9,904 | Total amount of fees paid to insurance company | USD $425 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $105,664 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,058 | Amount paid for insurance broker fees | 425 | Insurance broker organization code? | 3 | Insurance broker name | LISI, INC. |
|
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 ) |
Policy contract number | 612174 |
Policy instance | 3 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 83 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $1,436 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,593 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,436 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 16 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $2,323 | Total amount of fees paid to insurance company | USD $243 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $678 | Amount paid for insurance broker fees | 185 | Insurance broker organization code? | 3 | Insurance broker name | SARAH COURTNEY KNAPP |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 13 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $1,125 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,125 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
Policy contract number | 898641 |
Policy instance | 8 |
Insurance contract or identification number | 898641 | Number of Individuals Covered | 8 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $634 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,354 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $634 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
Policy contract number | 898641 |
Policy instance | 10 |
Insurance contract or identification number | 898641 | Number of Individuals Covered | 4 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $913 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,732 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $913 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 235493 |
Policy instance | 9 |
Insurance contract or identification number | 235493 | Number of Individuals Covered | 13 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $7,591 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $108,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,591 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 046-2799-00 |
Policy instance | 8 |
Insurance contract or identification number | 046-2799-00 | Number of Individuals Covered | 18 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $822 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $5,745 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $822 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICES |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 7 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 38 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $5,380 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,380 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 6 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 9 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $131 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $131 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 37136 |
Policy instance | 5 |
Insurance contract or identification number | 37136 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $933 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,096 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $933 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 4 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 111 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $17,419 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $583,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,419 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICES |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 23 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $5,403 | Total amount of fees paid to insurance company | USD $954 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,592 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,232 | Amount paid for insurance broker fees | 505 | Insurance broker organization code? | 3 | Insurance broker name | CLAUDIA MARABOTO |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 15 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $2,247 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,441 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,247 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 3 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 471 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $14,588 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $222,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,588 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 18 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $4,597 | Total amount of fees paid to insurance company | USD $1,148 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,099 | Amount paid for insurance broker fees | 467 | Insurance broker organization code? | 3 | Insurance broker name | ERIC WEBER SWANSON |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 21 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $3,235 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,866 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,235 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 6 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 10 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $126 | Other welfare benefits provided | ACUPUNCTURE & CHIROPRACTIC | Welfare Benefit Premiums Paid to Carrier | USD $1,259 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $126 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 3 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 398 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $20,436 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $393,785 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,436 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 4 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 152 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $24,125 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $801,496 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,962 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 37136 |
Policy instance | 5 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 7 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $1,699 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,741 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,552 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 7 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 38 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $5,380 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,380 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 046-2799-00 |
Policy instance | 8 |
Insurance contract or identification number | 046-2799-00 | Number of Individuals Covered | 16 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $1,627 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $11,320 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,627 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICES |
|
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 245493 |
Policy instance | 9 |
Insurance contract or identification number | 245493 | Number of Individuals Covered | 15 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $4,181 | Welfare Benefit Premiums Paid to Carrier | USD $132,360 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,181 | Insurance broker organization code? | 3 | Insurance broker name | WORD & BROWN INSURANCE |
|
KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
Policy contract number | KANAWHA -898641 |
Policy instance | 10 |
Insurance contract or identification number | KANAWHA -898641 | Number of Individuals Covered | 9 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $211 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $211 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 8 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 43 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $5,007 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,034 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,007 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 7 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 18 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $158 | Other welfare benefits provided | ACUPUNCTURE & CHIROPRACTIC | Welfare Benefit Premiums Paid to Carrier | USD $1,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $158 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 4 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 388 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $18,557 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $288,132 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,557 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | 64890A |
Policy instance | 3 |
Insurance contract or identification number | 64890A | Number of Individuals Covered | 52 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $33,579 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $717,848 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,579 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 22 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $4,939 | Total amount of fees paid to insurance company | USD $779 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,152 | Amount paid for insurance broker fees | 252 | Insurance broker organization code? | 3 | Insurance broker name | STABELL INSURANCE SERVICE |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 26 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $3,260 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,624 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,260 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 37136 |
Policy instance | 6 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 11 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $2,848 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,116 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,848 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 5 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 158 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2014-05-31 | Total amount of commissions paid to insurance broker | USD $25,537 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $842,225 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,537 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 151809 |
Policy instance | 1 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 48 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $5,850 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,850 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 8 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 36 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $3,801 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,904 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,801 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 7 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 24 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $3,870 | Total amount of fees paid to insurance company | USD $621 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,853 | 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 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1 | Insurance broker name | JOHN DAVID EVENGELISTA |
|
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | 64890A |
Policy instance | 6 |
Insurance contract or identification number | 64890A | Number of Individuals Covered | 77 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $42,353 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $863,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $42,353 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) |
Policy contract number | 612174 |
Policy instance | 5 |
Insurance contract or identification number | 612174 | Number of Individuals Covered | 390 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $19,578 | Total amount of fees paid to insurance company | USD $1,369 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $356,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,578 | Amount paid for insurance broker fees | 1369 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 4 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 183 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $28,760 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $971,155 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,760 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 37136 |
Policy instance | 3 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 25 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $4,478 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $164,939 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,478 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 2 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 19 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-05-31 | Total amount of commissions paid to insurance broker | USD $201 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,010 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $201 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 4 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 158 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $39,257 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,243,455 | 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 | 570392 |
Policy instance | 8 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 36 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $4,322 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,152 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 2 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 44 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $426 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,262 | 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 | 37136 |
Policy instance | 3 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 13 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $4,158 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $125,786 | 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 | 151809 |
Policy instance | 1 |
Insurance contract or identification number | 151809 | Number of Individuals Covered | 48 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $5,883 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | 64890A |
Policy instance | 5 |
Insurance contract or identification number | 64890A | Number of Individuals Covered | 99 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $49,693 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,036,168 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00396979 |
Policy instance | 6 |
Insurance contract or identification number | 00396979 | Number of Individuals Covered | 531 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $10,411 | Total amount of fees paid to insurance company | USD $13,395 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $388,433 | 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 | E3044807 |
Policy instance | 7 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 29 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,956 | Total amount of fees paid to insurance company | USD $1,256 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,865 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 7 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 68 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $613 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $6,131 | 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 | 37136 |
Policy instance | 6 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 14 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $3,557 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $113,962 | 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 | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 41 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $6,676 | Total amount of fees paid to insurance company | USD $2,101 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $42,697 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00396979 |
Policy instance | 3 |
Insurance contract or identification number | 00396979 | Number of Individuals Covered | 567 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $11,715 | Total amount of fees paid to insurance company | USD $1,199 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $461,496 | 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 | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 36 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $3,830 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $30,812 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | 64890A |
Policy instance | 4 |
Insurance contract or identification number | 64890A | Number of Individuals Covered | 134 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $54,705 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,199,861 | 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 | 225017 |
Policy instance | 5 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 173 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $32,673 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,054,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | 64890A |
Policy instance | 4 |
Insurance contract or identification number | 64890A | Number of Individuals Covered | 170 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $62,700 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,353,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,700 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICES |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 570392 |
Policy instance | 1 |
Insurance contract or identification number | 570392 | Number of Individuals Covered | 36 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $3,623 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $30,034 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,623 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00396979 |
Policy instance | 3 |
Insurance contract or identification number | 00396979 | Number of Individuals Covered | 589 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $10,404 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | 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 $414,536 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,404 | Insurance broker organization code? | 3 | Insurance broker name | ER INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225017 |
Policy instance | 5 |
Insurance contract or identification number | 225017 | Number of Individuals Covered | 155 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $26,050 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $868,654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $-30,675 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 37136 |
Policy instance | 6 |
Insurance contract or identification number | 37136 | Number of Individuals Covered | 14 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $2,793 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $90,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,793 | Insurance broker organization code? | 3 | Insurance broker name | JAMES BULOTTI |
|
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | LH408W*000 |
Policy instance | 7 |
Insurance contract or identification number | LH408W*000 | Number of Individuals Covered | 64 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $529 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $5,286 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $529 | Insurance broker organization code? | 3 | Insurance broker name | INTERWEST INSURANCE SERVICE |
|
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E3044807 |
Policy instance | 2 |
Insurance contract or identification number | E3044807 | Number of Individuals Covered | 41 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $6,851 | Total amount of fees paid to insurance company | USD $1,854 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $47,423 | 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 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1 | Insurance broker name | ER INSURANCE SERVICES |
|