GREAT STATE BEVERAGES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GREAT STATE BEVERAGES, INC.
401k plan membership statisitcs for GREAT STATE BEVERAGES, INC.
Measure | Date | Value |
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2016: GREAT STATE BEVERAGES, INC. 2016 401k membership |
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Total participants, beginning-of-year | 2016-09-01 | 122 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 0 |
Total of all active and inactive participants | 2016-09-01 | 0 |
2015: GREAT STATE BEVERAGES, INC. 2015 401k membership |
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Total participants, beginning-of-year | 2015-09-01 | 134 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 122 |
Total of all active and inactive participants | 2015-09-01 | 122 |
2014: GREAT STATE BEVERAGES, INC. 2014 401k membership |
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Total participants, beginning-of-year | 2014-09-01 | 117 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 134 |
Total of all active and inactive participants | 2014-09-01 | 134 |
2013: GREAT STATE BEVERAGES, INC. 2013 401k membership |
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Total participants, beginning-of-year | 2013-09-01 | 111 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 117 |
Total of all active and inactive participants | 2013-09-01 | 117 |
2012: GREAT STATE BEVERAGES, INC. 2012 401k membership |
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Total participants, beginning-of-year | 2012-09-01 | 111 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 111 |
Total of all active and inactive participants | 2012-09-01 | 111 |
2011: GREAT STATE BEVERAGES, INC. 2011 401k membership |
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Total participants, beginning-of-year | 2011-09-01 | 103 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 111 |
Total of all active and inactive participants | 2011-09-01 | 111 |
2010: GREAT STATE BEVERAGES, INC. 2010 401k membership |
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Total participants, beginning-of-year | 2010-09-01 | 101 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 103 |
Total of all active and inactive participants | 2010-09-01 | 103 |
2009: GREAT STATE BEVERAGES, INC. 2009 401k membership |
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Total participants, beginning-of-year | 2009-09-01 | 103 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 101 |
Total of all active and inactive participants | 2009-09-01 | 101 |
HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Number of Individuals Covered | 254 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $36,741 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,290,481 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,741 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 250 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $6,206 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $110,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,027 | Insurance broker organization code? | 3 | Insurance broker name | COMBINED SERVICES LLC |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 4 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $675 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $675 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010186939 |
Policy instance | 4 |
Insurance contract or identification number | 000010186939 | Number of Individuals Covered | 195 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,981 | Total amount of fees paid to insurance company | USD $1,098 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,346 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,981 | Amount paid for insurance broker fees | 1098 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010186041 |
Policy instance | 6 |
Insurance contract or identification number | 000010186041 | Number of Individuals Covered | 130 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-30 | Total amount of commissions paid to insurance broker | USD $1,446 | Total amount of fees paid to insurance company | USD $659 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,949 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,446 | Amount paid for insurance broker fees | 659 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010186940 |
Policy instance | 5 |
Insurance contract or identification number | 000010186940 | Number of Individuals Covered | 127 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $2,514 | Total amount of fees paid to insurance company | USD $901 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,640 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,514 | Amount paid for insurance broker fees | 901 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Number of Individuals Covered | 249 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $37,469 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,296,112 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,469 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010186939 |
Policy instance | 4 |
Insurance contract or identification number | 000010186939 | Number of Individuals Covered | 181 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $6,094 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,175 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,094 | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 259 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $6,555 | Total amount of fees paid to insurance company | USD $0 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $110,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,276 | Insurance broker organization code? | 3 | Insurance broker name | COMBINED SERVICES LLC |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 2 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $548 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $548 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 242 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $5,519 | Total amount of fees paid to insurance company | USD $0 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $91,165 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,461 | Insurance broker organization code? | 3 | Insurance broker name | COMBINED SERVICES LLC |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 2 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $535 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,740 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $535 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Number of Individuals Covered | 221 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $34,915 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,094,575 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,915 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00004051 |
Policy instance | 4 |
Insurance contract or identification number | AL00004051 | Number of Individuals Covered | 128 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $6,136 | Total amount of fees paid to insurance company | USD $256 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,381 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,136 | Amount paid for insurance broker fees | 256 | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 228 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,415 | Total amount of fees paid to insurance company | USD $0 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $87,967 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,372 | Insurance broker organization code? | 3 | Insurance broker name | COMBINED SERVICES LLC |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00004051 |
Policy instance | 4 |
Insurance contract or identification number | AL00004051 | Number of Individuals Covered | 121 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $6,169 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,169 | Insurance broker organization code? | 3 | Insurance broker name | CRONIN GERVINO & WARLICK, INC. |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 2 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $613 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,412 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $613 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $32,692 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,037,997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,692 | Insurance broker organization code? | 3 | Insurance broker name | CGI EMPLOYEE BENEFITS GROUP |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 2 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $613 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,412 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Number of Individuals Covered | 211 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $32,692 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,037,997 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 228 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,415 | Total amount of fees paid to insurance company | USD $0 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $87,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00004051 |
Policy instance | 4 |
Insurance contract or identification number | AL00004051 | Number of Individuals Covered | 121 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $6,169 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | AL00004051 |
Policy instance | 4 |
Insurance contract or identification number | AL00004051 | Number of Individuals Covered | 115 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $5,926 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,697 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 059941 |
Policy instance | 2 |
Insurance contract or identification number | 059941 | Number of Individuals Covered | 213 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $32,551 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,030,925 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 ) |
Policy contract number | 000001551 |
Policy instance | 1 |
Insurance contract or identification number | 000001551 | Number of Individuals Covered | 228 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $5,455 | Total amount of fees paid to insurance company | USD $0 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $87,924 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
Policy contract number | 059942 |
Policy instance | 3 |
Insurance contract or identification number | 059942 | Number of Individuals Covered | 2 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $599 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,741 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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