FORT COLLINS WOMEN'S CLINIC P.C. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 116 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 116 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 106 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 106 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 109 |
| Total of all active and inactive participants | 2020-01-01 | 109 |
| Total participants | 2020-01-01 | 109 |
| 2019: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 114 |
| Total of all active and inactive participants | 2019-01-01 | 114 |
| Total participants | 2019-01-01 | 114 |
| Number of participants with account balances | 2019-01-01 | 0 |
| 2018: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 107 |
| Total of all active and inactive participants | 2018-01-01 | 107 |
| Total participants | 2018-01-01 | 107 |
| 2017: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 113 |
| Total of all active and inactive participants | 2017-01-01 | 113 |
| Total participants | 2017-01-01 | 113 |
| 2016: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 104 |
| Total of all active and inactive participants | 2016-01-01 | 104 |
| Total participants | 2016-01-01 | 104 |
| 2015: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 108 |
| Total of all active and inactive participants | 2015-01-01 | 108 |
| Total participants | 2015-01-01 | 0 |
| 2014: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 103 |
| Total of all active and inactive participants | 2014-01-01 | 103 |
| Total participants | 2014-01-01 | 0 |
| 2022: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FORT COLLINS WOMEN'S CLINIC, PC HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 949559 |
| Policy instance | 1 |
| Insurance contract or identification number | 949559 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,327 | | Total amount of fees paid to insurance company | USD $8,598 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $204,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,327 | | Amount paid for insurance broker fees | 8598 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 334192 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $51,057 | | Total amount of fees paid to insurance company | USD $2,036 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $300,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,530 | | Amount paid for insurance broker fees | 2036 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ASX5 |
| Policy instance | 3 |
| Insurance contract or identification number | G000ASX5 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-07-01 | | Total amount of commissions paid to insurance broker | USD $57,933 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $297,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,422 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00612623 |
| Policy instance | 2 |
| Insurance contract or identification number | 00612623 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $36,774 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $349,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,774 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 00334192 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $11,560 | | Total amount of fees paid to insurance company | USD $3,742 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACDT,AD&D,CNCR,CRIT ILL,OPT LIFE,HI | | Welfare Benefit Premiums Paid to Carrier | USD $78,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,560 | | Amount paid for insurance broker fees | 3742 | | Additional information about fees paid to insurance broker | FEES REQD TO BE REPORTED, ELEMENT (C) | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ASX5 |
| Policy instance | 3 |
| Insurance contract or identification number | G000ASX5 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-07-01 | | Total amount of commissions paid to insurance broker | USD $51,477 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $264,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,016 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00612623 |
| Policy instance | 2 |
| Insurance contract or identification number | 00612623 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $36,053 | | Total amount of fees paid to insurance company | USD $1,386 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $322,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,053 | | Amount paid for insurance broker fees | 1386 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 00334192 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,780 | | Total amount of fees paid to insurance company | USD $4,243 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACDT,AD&D,CNCR,CRIT ILL,OPT LIFE,HI | | Welfare Benefit Premiums Paid to Carrier | USD $80,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,780 | | Amount paid for insurance broker fees | 4243 | | Additional information about fees paid to insurance broker | FEES REQD TO BE REPORTED, ELEMENT (C) | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ASX5 |
| Policy instance | 3 |
| Insurance contract or identification number | G000ASX5 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-07-01 | | Total amount of commissions paid to insurance broker | USD $52,220 | | Total amount of fees paid to insurance company | USD $5,913 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $267,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,016 | | Amount paid for insurance broker fees | 5625 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00612623 |
| Policy instance | 2 |
| Insurance contract or identification number | 00612623 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $34,060 | | Total amount of fees paid to insurance company | USD $1,640 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $327,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,060 | | Amount paid for insurance broker fees | 1640 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 00334192 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $11,392 | | Total amount of fees paid to insurance company | USD $3,516 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCDT,AD&D,CANCER,CRIT ILL,OPT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $76,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,392 | | Amount paid for insurance broker fees | 3516 | | Additional information about fees paid to insurance broker | FEES REQD TO BE REPORTED, ELEMENT (C) | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000ASX5 |
| Policy instance | 3 |
| Insurance contract or identification number | G000ASX5 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-07-01 | | Total amount of commissions paid to insurance broker | USD $52,583 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | VOLUNTARY SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $257,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,463 | | Insurance broker organization code? | 3 | | Insurance broker name | PFS INSURANCE GROUP LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 00334192 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,518 | | Total amount of fees paid to insurance company | USD $7,207 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCDT,AD&D,CANCER,CRIT ILL,OPT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $123,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,410 | | Amount paid for insurance broker fees | 7207 | | Additional information about fees paid to insurance broker | FEES REQD TO BE REPORTED, ELEMENT (C) | | Insurance broker organization code? | 3 | | Insurance broker name | WEALTH STRATEGIES GROUP LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00612623 |
| Policy instance | 2 |
| Insurance contract or identification number | 00612623 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $27,811 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $318,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,811 | | Insurance broker organization code? | 3 | | Insurance broker name | PFS INSURANCE GROUP LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00612623 |
| Policy instance | 2 |
| Insurance contract or identification number | 00612623 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $23,625 | | Total amount of fees paid to insurance company | USD $1,785 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $225,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,625 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1785 | | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION PAYMENTS | | Insurance broker name | PFS INSURANCE GROUP LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 1 |
| Insurance contract or identification number | 00334192 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $9,170 | | Total amount of fees paid to insurance company | USD $835 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, CANCER, CRIT ILL, OPT LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $113,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,048 | | Amount paid for insurance broker fees | 835 | | Additional information about fees paid to insurance broker | FEES REQD TO BE REPORTED, ELEMENT (C) | | Insurance broker organization code? | 3 | | Insurance broker name | V.W. ALLABASHI & ASSOC., LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00334192 |
| Policy instance | 3 |
| Insurance contract or identification number | 00334192 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,993 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $89,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,290 | | Insurance broker organization code? | 3 | | Insurance broker name | V.W. ALLABASHI & ASSOC., LLC |
|
| STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
| Policy contract number | IHCRS0046014 |
| Policy instance | 2 |
| Insurance contract or identification number | IHCRS0046014 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $23,159 | | Welfare Benefit Premiums Paid to Carrier | USD $154,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,159 | | Insurance broker organization code? | 3 | | Insurance broker name | COSTPLUS ADVISORS |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-7778 |
| Policy instance | 1 |
| Insurance contract or identification number | 949-7778 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $945 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $9,453 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $945 | | Insurance broker organization code? | 3 | | Insurance broker name | GPA |
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