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MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan NameMENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN
Plan identification number 501

MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

MENTAL HEALTH PARTNERS has sponsored the creation of one or more 401k plans.

Company Name:MENTAL HEALTH PARTNERS
Employer identification number (EIN):840520493
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Additional information about MENTAL HEALTH PARTNERS

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1962-11-16
Company Identification Number: 19871163594
Legal Registered Office Address: 1455 Dixon Ave Ste 300

Lafayette
United States of America (USA)
80026

More information about MENTAL HEALTH PARTNERS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01EMILY HARDY-GREEN2023-11-07
5012021-07-01EMILY HARDY-GREEN2023-03-02
5012020-07-01EMILY HARDY-GREEN2021-12-16
5012020-07-01EMILY HARDY-GREEN2023-03-02
5012019-07-01EMILY HARDY-GREEN2020-10-19
5012019-07-01EMILY HARDY-GREEN2023-03-02
5012018-07-01EMILY HARDY-GREEN2019-11-22
5012017-07-01
5012016-07-01
5012015-07-01EMILY HARDY-GREEN
5012014-07-01EMILY HARDY
5012013-07-01GALEN GAARDER
5012012-07-01BRUCE SHAVER
5012011-07-01BRUCE SHAVER BRUCE SHAVER2013-01-30
5012010-07-01BRUCE SHAVER
5012009-07-01BRUCE SHAVER BRUCE SHAVER2011-03-03
5012007-07-01BRUCE SHAVER
5012006-07-01BRUCE SHAVER
5012005-07-01BRUCE SHAVER
5012004-07-01BRUCE SHAVER
5012003-07-01BRUCE SHAVER
5012002-07-01BRUCE SHAVER

Plan Statistics for MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN

Measure Date Value
2022: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01399
Total number of active participants reported on line 7a of the Form 55002022-07-01477
Number of retired or separated participants receiving benefits2022-07-012
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01479
Number of employers contributing to the scheme2022-07-010
2021: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01283
Total number of active participants reported on line 7a of the Form 55002021-07-01289
Number of retired or separated participants receiving benefits2021-07-012
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01291
Number of employers contributing to the scheme2021-07-010
2020: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01280
Total number of active participants reported on line 7a of the Form 55002020-07-01275
Number of retired or separated participants receiving benefits2020-07-011
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01276
Number of employers contributing to the scheme2020-07-010
2019: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01237
Total number of active participants reported on line 7a of the Form 55002019-07-01215
Number of retired or separated participants receiving benefits2019-07-011
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01216
Number of employers contributing to the scheme2019-07-010
2018: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01253
Total number of active participants reported on line 7a of the Form 55002018-07-01282
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01282
Number of employers contributing to the scheme2018-07-010
2017: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01325
Total number of active participants reported on line 7a of the Form 55002017-07-01250
Number of retired or separated participants receiving benefits2017-07-013
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01253
2016: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01342
Total number of active participants reported on line 7a of the Form 55002016-07-01325
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01325
2015: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01371
Total number of active participants reported on line 7a of the Form 55002015-07-01340
Number of retired or separated participants receiving benefits2015-07-012
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01342
2014: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01336
Total number of active participants reported on line 7a of the Form 55002014-07-01361
Number of retired or separated participants receiving benefits2014-07-0110
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01371
2013: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01287
Total number of active participants reported on line 7a of the Form 55002013-07-01326
Number of retired or separated participants receiving benefits2013-07-0110
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01336
2012: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01285
Total number of active participants reported on line 7a of the Form 55002012-07-01275
Number of retired or separated participants receiving benefits2012-07-0110
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01285
2011: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01264
Total number of active participants reported on line 7a of the Form 55002011-07-01265
Number of retired or separated participants receiving benefits2011-07-018
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01273
2010: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01264
Total number of active participants reported on line 7a of the Form 55002010-07-01253
Number of retired or separated participants receiving benefits2010-07-0111
Total of all active and inactive participants2010-07-01264
Total participants2010-07-01264
2009: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01256
Total number of active participants reported on line 7a of the Form 55002009-07-01253
Number of retired or separated participants receiving benefits2009-07-0111
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01264
2007: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year2007-07-01257
Total number of active participants reported on line 7a of the Form 55002007-07-01257
Number of retired or separated participants receiving benefits2007-07-010
Number of other retired or separated participants entitled to future benefits2007-07-010
Total of all active and inactive participants2007-07-01257
Total participants2007-07-01257
2006: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year2006-07-01257
Total number of active participants reported on line 7a of the Form 55002006-07-01257
Number of retired or separated participants receiving benefits2006-07-010
Number of other retired or separated participants entitled to future benefits2006-07-010
Total of all active and inactive participants2006-07-01257
Total participants2006-07-01257
2005: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year2005-07-01256
Total number of active participants reported on line 7a of the Form 55002005-07-01257
Number of retired or separated participants receiving benefits2005-07-010
Number of other retired or separated participants entitled to future benefits2005-07-010
Total of all active and inactive participants2005-07-01257
Total participants2005-07-01257
2004: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year2004-07-01250
Total number of active participants reported on line 7a of the Form 55002004-07-01256
Number of retired or separated participants receiving benefits2004-07-010
Number of other retired or separated participants entitled to future benefits2004-07-010
Total of all active and inactive participants2004-07-01256
Total participants2004-07-01256
2003: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2003 401k membership
Total participants, beginning-of-year2003-07-01250
Total number of active participants reported on line 7a of the Form 55002003-07-01250
Number of retired or separated participants receiving benefits2003-07-010
Number of other retired or separated participants entitled to future benefits2003-07-010
Total of all active and inactive participants2003-07-01250
Total participants2003-07-01250
2002: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2002 401k membership
Total participants, beginning-of-year2002-07-01250
Total number of active participants reported on line 7a of the Form 55002002-07-01250
Number of retired or separated participants receiving benefits2002-07-010
Number of other retired or separated participants entitled to future benefits2002-07-010
Total of all active and inactive participants2002-07-01250
Total participants2002-07-01250

Form 5500 Responses for MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN

2022: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedYes
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedYes
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2010: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes
2007: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01Submission has been amendedNo
2007-07-01This submission is the final filingNo
2007-07-01This return/report is a short plan year return/report (less than 12 months)No
2007-07-01Plan is a collectively bargained planNo
2007-07-01Plan funding arrangement – InsuranceYes
2007-07-01Plan benefit arrangement – InsuranceYes
2006: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2006 form 5500 responses
2006-07-01Type of plan entitySingle employer plan
2006-07-01Submission has been amendedNo
2006-07-01This submission is the final filingNo
2006-07-01This return/report is a short plan year return/report (less than 12 months)No
2006-07-01Plan is a collectively bargained planNo
2006-07-01Plan funding arrangement – InsuranceYes
2006-07-01Plan benefit arrangement – InsuranceYes
2005: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2005 form 5500 responses
2005-07-01Type of plan entitySingle employer plan
2005-07-01Submission has been amendedNo
2005-07-01This submission is the final filingNo
2005-07-01This return/report is a short plan year return/report (less than 12 months)No
2005-07-01Plan is a collectively bargained planNo
2005-07-01Plan funding arrangement – InsuranceYes
2005-07-01Plan benefit arrangement – InsuranceYes
2004: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2004 form 5500 responses
2004-07-01Type of plan entitySingle employer plan
2004-07-01Submission has been amendedNo
2004-07-01This submission is the final filingNo
2004-07-01This return/report is a short plan year return/report (less than 12 months)No
2004-07-01Plan is a collectively bargained planNo
2004-07-01Plan funding arrangement – InsuranceYes
2004-07-01Plan benefit arrangement – InsuranceYes
2003: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2003 form 5500 responses
2003-07-01Type of plan entitySingle employer plan
2003-07-01Submission has been amendedNo
2003-07-01This submission is the final filingNo
2003-07-01This return/report is a short plan year return/report (less than 12 months)No
2003-07-01Plan is a collectively bargained planNo
2003-07-01Plan funding arrangement – InsuranceYes
2003-07-01Plan benefit arrangement – InsuranceYes
2002: MENTAL HEALTH CENTER OF BOULDER COUNTY INC. FLEXIBLE BENEFITS PLAN 2002 form 5500 responses
2002-07-01Type of plan entitySingle employer plan
2002-07-01Submission has been amendedNo
2002-07-01This submission is the final filingNo
2002-07-01This return/report is a short plan year return/report (less than 12 months)No
2002-07-01Plan is a collectively bargained planNo
2002-07-01Plan funding arrangement – InsuranceYes
2002-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BD53
Policy instance 5
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number636479
Policy instance 4
MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number15585
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 2
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 2
MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number15585
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BD53
Policy instance 4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BD53
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 2
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96950991001
Policy instance 2
Insurance contract or identification number96950991001
Number of Individuals Covered297
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $3,549
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1
Insurance contract or identification number12314
Number of Individuals Covered413
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $10,639
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 3
Insurance contract or identification number5281
Number of Individuals Covered437
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $45,344
Total amount of fees paid to insurance companyUSD $1,735
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,945,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BD53
Policy instance 4
Insurance contract or identification numberGLUG0BD53
Number of Individuals Covered194
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $18,189
Total amount of fees paid to insurance companyUSD $10,230
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $134,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BD53
Policy instance 4
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96950991001
Policy instance 2
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number477950
Policy instance 4
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number5281
Policy instance 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96950991001
Policy instance 2
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number12314
Policy instance 1

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