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EMPLOYEE HEALTH AND DENTAL INSURANCE 401k Plan overview

Plan NameEMPLOYEE HEALTH AND DENTAL INSURANCE
Plan identification number 502

EMPLOYEE HEALTH AND DENTAL INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

BAYHEALTH MEDICAL CENTER, INC has sponsored the creation of one or more 401k plans.

Company Name:BAYHEALTH MEDICAL CENTER, INC
Employer identification number (EIN):510064318
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about BAYHEALTH MEDICAL CENTER, INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 0179203

More information about BAYHEALTH MEDICAL CENTER, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH AND DENTAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01MICHAEL TRETINA
5022016-01-01MICHAEL TRETINA
5022015-01-01MICHAEL J. TRETINA
5022014-01-01MICHAEL J. TRETINA
5022013-01-01SHANA ROSS
5022012-01-01SHANA ROSS
5022011-01-01RUTH WARNER
5022010-01-01RUTH WARNER
5022009-01-01JON MCDOWELL

Plan Statistics for EMPLOYEE HEALTH AND DENTAL INSURANCE

401k plan membership statisitcs for EMPLOYEE HEALTH AND DENTAL INSURANCE

Measure Date Value
2022: EMPLOYEE HEALTH AND DENTAL INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-01-013,209
Total number of active participants reported on line 7a of the Form 55002022-01-012,822
Number of retired or separated participants receiving benefits2022-01-0117
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-012,839
2021: EMPLOYEE HEALTH AND DENTAL INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-01-013,173
Total number of active participants reported on line 7a of the Form 55002021-01-013,155
Number of retired or separated participants receiving benefits2021-01-0154
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-013,209
2020: EMPLOYEE HEALTH AND DENTAL INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-01-013,172
Total number of active participants reported on line 7a of the Form 55002020-01-013,131
Number of retired or separated participants receiving benefits2020-01-0142
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-013,173
2019: EMPLOYEE HEALTH AND DENTAL INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-01-012,978
Total number of active participants reported on line 7a of the Form 55002019-01-013,093
Number of retired or separated participants receiving benefits2019-01-0179
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-013,172
2018: EMPLOYEE HEALTH AND DENTAL INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-01-012,828
Total number of active participants reported on line 7a of the Form 55002018-01-012,897
Number of retired or separated participants receiving benefits2018-01-0181
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-012,978
2017: EMPLOYEE HEALTH AND DENTAL INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-01-012,778
Total number of active participants reported on line 7a of the Form 55002017-01-012,774
Number of retired or separated participants receiving benefits2017-01-0154
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-012,828
2016: EMPLOYEE HEALTH AND DENTAL INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-012,813
Total number of active participants reported on line 7a of the Form 55002016-01-012,714
Number of retired or separated participants receiving benefits2016-01-015
Number of other retired or separated participants entitled to future benefits2016-01-0159
Total of all active and inactive participants2016-01-012,778
2015: EMPLOYEE HEALTH AND DENTAL INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-012,641
Total number of active participants reported on line 7a of the Form 55002015-01-012,813
Total of all active and inactive participants2015-01-012,813
Total participants2015-01-010
2014: EMPLOYEE HEALTH AND DENTAL INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-012,464
Total number of active participants reported on line 7a of the Form 55002014-01-012,641
Total of all active and inactive participants2014-01-012,641
Total participants2014-01-010
2013: EMPLOYEE HEALTH AND DENTAL INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-012,475
Total number of active participants reported on line 7a of the Form 55002013-01-012,464
Total of all active and inactive participants2013-01-012,464
Total participants2013-01-010
2012: EMPLOYEE HEALTH AND DENTAL INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-012,371
Total number of active participants reported on line 7a of the Form 55002012-01-012,377
Number of retired or separated participants receiving benefits2012-01-0198
Total of all active and inactive participants2012-01-012,475
Total participants2012-01-010
2011: EMPLOYEE HEALTH AND DENTAL INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-014,059
Total number of active participants reported on line 7a of the Form 55002011-01-014,516
Number of retired or separated participants receiving benefits2011-01-0193
Total of all active and inactive participants2011-01-014,609
Total participants2011-01-014,609
2010: EMPLOYEE HEALTH AND DENTAL INSURANCE 2010 401k membership
Total participants, beginning-of-year2010-01-012,191
Total number of active participants reported on line 7a of the Form 55002010-01-012,052
Number of retired or separated participants receiving benefits2010-01-0189
Total of all active and inactive participants2010-01-012,141
Total participants2010-01-012,141
2009: EMPLOYEE HEALTH AND DENTAL INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-012,016
Total number of active participants reported on line 7a of the Form 55002009-01-012,052
Number of retired or separated participants receiving benefits2009-01-01139
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-012,191

Form 5500 Responses for EMPLOYEE HEALTH AND DENTAL INSURANCE

2022: EMPLOYEE HEALTH AND DENTAL INSURANCE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: EMPLOYEE HEALTH AND DENTAL INSURANCE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: EMPLOYEE HEALTH AND DENTAL INSURANCE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: EMPLOYEE HEALTH AND DENTAL INSURANCE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: EMPLOYEE HEALTH AND DENTAL INSURANCE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: EMPLOYEE HEALTH AND DENTAL INSURANCE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: EMPLOYEE HEALTH AND DENTAL INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: EMPLOYEE HEALTH AND DENTAL INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: EMPLOYEE HEALTH AND DENTAL INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: EMPLOYEE HEALTH AND DENTAL INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: EMPLOYEE HEALTH AND DENTAL INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: EMPLOYEE HEALTH AND DENTAL INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: EMPLOYEE HEALTH AND DENTAL INSURANCE 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: EMPLOYEE HEALTH AND DENTAL INSURANCE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2857
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered3013
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2977
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2893
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2669
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2565
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2587
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2388
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 2
Insurance contract or identification number731
Number of Individuals Covered2151
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )
Policy contract number10006235
Policy instance 1
Insurance contract or identification number10006235
Number of Individuals Covered4839
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2101
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )
Policy contract number116626
Policy instance 2
Insurance contract or identification number116626
Number of Individuals Covered4795
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedMEDICARE SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $1,084,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )
Policy contract number116626
Policy instance 2
Insurance contract or identification number116626
Number of Individuals Covered4609
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $-15,000
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedMEDICARE SUPPLEMENTAL
Welfare Benefit Premiums Paid to CarrierUSD $961,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered2027
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 )
Policy contract number116626
Policy instance 2
Insurance contract or identification number116626
Number of Individuals Covered4059
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of fees paid to insurance companyUSD $135,000
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $729,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees135000
Additional information about fees paid to insurance brokerBROKER CONSULTING SERVICES
Insurance broker organization code?5
Insurance broker nameBLUE CROSS BLUE SHIELD OF DELAWARE,
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number731
Policy instance 1
Insurance contract or identification number731
Number of Individuals Covered1898
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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