PROGRESSIVE HEALTH REHABILITATION, has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN
401k plan membership statisitcs for PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN
| Measure | Date | Value |
|---|
| 2022: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 848 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 798 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 798 |
| 2021: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 813 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 848 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 848 |
| 2020: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 819 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 813 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 813 |
| 2019: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 825 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 819 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 819 |
| 2018: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 742 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 825 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 825 |
| 2017: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 700 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 742 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 742 |
| Total participants | 2017-06-01 | 742 |
| 2016: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 700 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 0 |
| 2015: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 520 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 0 |
| 2014: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 465 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 520 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 520 |
| 2013: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 465 |
| Total of all active and inactive participants | 2013-10-01 | 465 |
| 2012: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 310 |
| Total of all active and inactive participants | 2012-10-01 | 310 |
| 2011: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 106 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
| Total of all active and inactive participants | 2011-10-01 | 106 |
| 2009: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 189 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
| Total of all active and inactive participants | 2009-10-01 | 189 |
| 2022: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2022 form 5500 responses |
|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2021 form 5500 responses |
|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: PROGRESSIVE HEALTH REHABILITATION LLC GROUP DENTAL PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 893871G |
| Policy instance | 2 |
| Insurance contract or identification number | 893871G | | Number of Individuals Covered | 228 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $24,910 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,910 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 798 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $6,804 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,804 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 893871G |
| Policy instance | 2 |
| Insurance contract or identification number | 893871G | | Number of Individuals Covered | 209 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $25,111 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,034 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 848 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $6,639 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,639 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 877025 |
| Policy instance | 2 |
| Insurance contract or identification number | 877025 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $9,661 | | Total amount of fees paid to insurance company | USD $725 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,661 | | Amount paid for insurance broker fees | 725 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 813 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 877025 |
| Policy instance | 2 |
| Insurance contract or identification number | 877025 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $18,072 | | Total amount of fees paid to insurance company | USD $1,011 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,072 | | Amount paid for insurance broker fees | 1011 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 819 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $7,178 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,178 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 877025 |
| Policy instance | 2 |
| Insurance contract or identification number | 877025 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $13,171 | | Total amount of fees paid to insurance company | USD $1,730 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,171 | | Amount paid for insurance broker fees | 1730 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 825 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $6,144 | | Total amount of fees paid to insurance company | USD $1,774 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,144 | | Amount paid for insurance broker fees | 1774 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600539 |
| Policy instance | 2 |
| Insurance contract or identification number | VDT600539 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $14,291 | | Total amount of fees paid to insurance company | USD $3,213 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 742 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $7,620 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600539 |
| Policy instance | 2 |
| Insurance contract or identification number | VDT600539 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $8,866 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,866 | | Insurance broker organization code? | 3 | | Insurance broker name | CLIPPENGER FINANCIAL GROUP |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $3,855 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,855 | | Insurance broker organization code? | 3 | | Insurance broker name | CLIPPINGER FINANCIAL GROUP |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600539 |
| Policy instance | 2 |
| Insurance contract or identification number | VDT600539 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $8,114 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,114 | | Insurance broker organization code? | 3 | | Insurance broker name | CLIPPENGER FINANCIAL GROUP |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 465 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $4,600 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,600 | | Insurance broker organization code? | 3 | | Insurance broker name | CLIPPINGER FINANCIAL GROUP |
|
| DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 ) |
| Policy contract number | 235 |
| Policy instance | 1 |
| Insurance contract or identification number | 235 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $3,188 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,188 | | Insurance broker organization code? | 3 | | Insurance broker name | CLIPPINGER FINANCIAL GROUP |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600539 |
| Policy instance | 1 |
| Insurance contract or identification number | VDT600539 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $5,467 | | Total amount of fees paid to insurance company | USD $663 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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