TRAVIZON, INC has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2015: TRAVIZON INC 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 304 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 265 |
| Total of all active and inactive participants | 2015-01-01 | 265 |
| 2014: TRAVIZON INC 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 292 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 304 |
| Total of all active and inactive participants | 2014-01-01 | 304 |
| 2013: TRAVIZON INC 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 292 |
| Total of all active and inactive participants | 2013-01-01 | 292 |
| 2012: TRAVIZON INC 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 286 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 4 |
| Total of all active and inactive participants | 2012-01-01 | 290 |
| 2011: TRAVIZON INC 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 303 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 269 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 12 |
| Total of all active and inactive participants | 2011-01-01 | 281 |
| 2010: TRAVIZON INC 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 312 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 303 |
| Total of all active and inactive participants | 2010-01-01 | 303 |
| 2009: TRAVIZON INC 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 312 |
| Total of all active and inactive participants | 2009-01-01 | 312 |
| Total participants | 2009-01-01 | 312 |
| 2008: TRAVIZON INC 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 242 |
| Total of all active and inactive participants | 2008-01-01 | 242 |
| 2015: TRAVIZON INC 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: TRAVIZON INC 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: TRAVIZON INC 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: TRAVIZON INC 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: TRAVIZON INC 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: TRAVIZON INC 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: TRAVIZON INC 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: TRAVIZON INC 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,090 | | Total amount of fees paid to insurance company | USD $930 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $155,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,090 | | Amount paid for insurance broker fees | 930 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9944018 |
| Policy instance | 3 |
| Insurance contract or identification number | 9944018 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $769 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $769 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 50119000 |
| Policy instance | 2 |
| Insurance contract or identification number | 50119000 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-30 | | Total amount of commissions paid to insurance broker | USD $10,203 | | Total amount of fees paid to insurance company | USD $4,183 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $340,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,203 | | Amount paid for insurance broker fees | 4183 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP LLC |
|
| TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 ) |
| Policy contract number | 45926000 |
| Policy instance | 1 |
| Insurance contract or identification number | 45926000 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $21,043 | | Total amount of fees paid to insurance company | USD $8,656 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $726,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,043 | | Amount paid for insurance broker fees | 8656 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP, LLC |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 50119000 |
| Policy instance | 2 |
| Insurance contract or identification number | 50119000 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-30 | | Total amount of commissions paid to insurance broker | USD $10,531 | | Total amount of fees paid to insurance company | USD $4,249 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $334,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,531 | | Amount paid for insurance broker fees | 4249 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP, LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,486 | | Total amount of fees paid to insurance company | USD $2,187 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $137,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,486 | | Amount paid for insurance broker fees | 2187 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 ) |
| Policy contract number | 45926000 |
| Policy instance | 1 |
| Insurance contract or identification number | 45926000 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,665 | | Total amount of fees paid to insurance company | USD $7,549 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $692,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,665 | | Amount paid for insurance broker fees | 7549 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP, LLC |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 45926000 |
| Policy instance | 1 |
| Insurance contract or identification number | 45926000 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $17,078 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $566,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,078 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP, LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,458 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,458 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 50119000 |
| Policy instance | 2 |
| Insurance contract or identification number | 50119000 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-30 | | Total amount of commissions paid to insurance broker | USD $10,212 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $308,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,212 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN BENEFITS GROUP, LLC |
|
| HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
| Policy contract number | 0715634 |
| Policy instance | 3 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,950 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $504,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,950 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0715634 |
| Policy instance | 2 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,746 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $502,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,746 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,554 | | Total amount of fees paid to insurance company | USD $237 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $150,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,554 | | Amount paid for insurance broker fees | 237 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0715634 |
| Policy instance | 2 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $23,458 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $435,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $7,350 | | Total amount of fees paid to insurance company | USD $2,819 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $140,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
| Policy contract number | 0715634 |
| Policy instance | 3 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $29,629 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $519,483 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 303 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $15,986 | | Total amount of fees paid to insurance company | USD $2,833 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $133,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,835 | | Amount paid for insurance broker fees | 2253 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0715634 |
| Policy instance | 2 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $14,351 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $479,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,569 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
|
| HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
| Policy contract number | 0715634 |
| Policy instance | 3 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $21,760 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $717,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,760 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP INS BROKERAGE |
|
| HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 ) |
| Policy contract number | 0715634 |
| Policy instance | 1 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $26,547 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $647,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,547 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP INS BROKERAGE |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731335 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05731335 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $15,817 | | Total amount of fees paid to insurance company | USD $2,391 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $139,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,817 | | Amount paid for insurance broker fees | 2391 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0715634 |
| Policy instance | 3 |
| Insurance contract or identification number | 0715634 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2009-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $17,611 | | Health Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $17,611 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP INS BROKERAGE |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 28966 |
| Policy instance | 1 |
| Insurance contract or identification number | 28966 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2007-12-01 | | Insurance policy end date | 2008-11-30 | | Total amount of commissions paid to insurance broker | USD $5,489 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,489 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP INS BROKERAGE |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5321872 |
| Policy instance | 3 |
| Insurance contract or identification number | 5321872 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $16,444 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,444 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00388349 |
| Policy instance | 2 |
| Insurance contract or identification number | 00388349 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $3,334 | | Total amount of fees paid to insurance company | USD $3,254 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $151,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3254 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | CUSTOM BENE GROUP INS |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3326832 |
| Policy instance | 3 |
| Insurance contract or identification number | 3326832 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2007-01-01 | | Insurance policy end date | 2007-12-31 | | Total amount of commissions paid to insurance broker | USD $62,811 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,258,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,811 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 28966 |
| Policy instance | 1 |
| Insurance contract or identification number | 28966 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2006-12-01 | | Insurance policy end date | 2007-11-30 | | Total amount of commissions paid to insurance broker | USD $5,143 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,143 | | Insurance broker organization code? | 3 | | Insurance broker name | CUSTOM BENEFITS GROUP INSURANCE |
|
