401k Plan data: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN plan

ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 401k Plan overview

Plan Name	ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN
Plan identification number	502

ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

ICE PARTNERS LLC has sponsored the creation of one or more 401k plans.

Company Name: ICE PARTNERS LLC

Employer identification number (EIN): 203612825

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Additional information about ICE PARTNERS LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 200529810025

More information about ICE PARTNERS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 GREGORY A. ARVESEN
502 2015-01-01 GREGORY A. ARVESEN
502 2014-01-01 GREGORY A. ARVESEN
502 2013-01-01 GREGORY A. ARVESEN
502 2012-01-01 GREGORY A. ARVESEN
502 2011-01-01 GREGORY A ARVESEN
502 2010-01-01 GREGORY A ARVESEN
502 2009-01-01 GREGORY A ARVESEN

Plan id#	Filing Submission Date	Name of Administrator
502	2016-01-01	GREGORY A. ARVESEN
502	2015-01-01	GREGORY A. ARVESEN
502	2014-01-01	GREGORY A. ARVESEN
502	2013-01-01	GREGORY A. ARVESEN
502	2012-01-01	GREGORY A. ARVESEN
502	2011-01-01	GREGORY A ARVESEN
502	2010-01-01	GREGORY A ARVESEN
502	2009-01-01	GREGORY A ARVESEN

Plan Statistics for ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN

401k plan membership statisitcs for ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN

Measure Date Value
2016: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 430
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 453
Number of retired or separated participants receiving benefits 2016-01-01 11
Total of all active and inactive participants 2016-01-01 464
Total participants 2016-01-01 464
2015: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 416
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 419
Number of retired or separated participants receiving benefits 2015-01-01 11
Total of all active and inactive participants 2015-01-01 430
Total participants 2015-01-01 0
2014: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 382
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 416
Number of retired or separated participants receiving benefits 2014-01-01 5
Total of all active and inactive participants 2014-01-01 421
Total participants 2014-01-01 0
2013: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 402
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 367
Number of retired or separated participants receiving benefits 2013-01-01 15
Total of all active and inactive participants 2013-01-01 382
Total participants 2013-01-01 0
2012: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 408
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 384
Number of retired or separated participants receiving benefits 2012-01-01 18
Total of all active and inactive participants 2012-01-01 402
Total participants 2012-01-01 0
2011: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 383
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 395
Number of retired or separated participants receiving benefits 2011-01-01 13
Total of all active and inactive participants 2011-01-01 408
Total participants 2011-01-01 408
2010: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 426
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 362
Number of retired or separated participants receiving benefits 2010-01-01 21
Total of all active and inactive participants 2010-01-01 383
Total participants 2010-01-01 383
2009: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 460
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 402
Number of retired or separated participants receiving benefits 2009-01-01 24
Total of all active and inactive participants 2009-01-01 426
Total participants 2009-01-01 426

Measure	Date	Value
2016: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	430
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	453
Number of retired or separated participants receiving benefits	2016-01-01	11
Total of all active and inactive participants	2016-01-01	464
Total participants	2016-01-01	464
2015: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	416
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	419
Number of retired or separated participants receiving benefits	2015-01-01	11
Total of all active and inactive participants	2015-01-01	430
Total participants	2015-01-01	0
2014: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	382
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	416
Number of retired or separated participants receiving benefits	2014-01-01	5
Total of all active and inactive participants	2014-01-01	421
Total participants	2014-01-01	0
2013: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	402
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	367
Number of retired or separated participants receiving benefits	2013-01-01	15
Total of all active and inactive participants	2013-01-01	382
Total participants	2013-01-01	0
2012: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	408
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	384
Number of retired or separated participants receiving benefits	2012-01-01	18
Total of all active and inactive participants	2012-01-01	402
Total participants	2012-01-01	0
2011: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	395
Number of retired or separated participants receiving benefits	2011-01-01	13
Total of all active and inactive participants	2011-01-01	408
Total participants	2011-01-01	408
2010: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	426
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	362
Number of retired or separated participants receiving benefits	2010-01-01	21
Total of all active and inactive participants	2010-01-01	383
Total participants	2010-01-01	383
2009: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	460
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	402
Number of retired or separated participants receiving benefits	2009-01-01	24
Total of all active and inactive participants	2009-01-01	426
Total participants	2009-01-01	426

Form 5500 Responses for ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN

2016: ICM PARTNERS LIFE/MED/AD&D/DENTAL 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: ICM PARTNERS LIFE/MED/AD&D/DENTAL 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: ICM PARTNERS LIFE/MED/AD&D/DENTAL 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
2013: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ICM PARTNERS LIFE/MED/AD&D/DENTAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	86
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $638
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $638
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

573702

Policy instance

Insurance contract or identification number	573702
Number of Individuals Covered	117
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

932432

Policy instance

Insurance contract or identification number	932432
Number of Individuals Covered	50
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $24,534
Total amount of fees paid to insurance company	USD $1,074
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $123,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,267
Amount paid for insurance broker fees	1074
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0805080HNO

Policy instance

Insurance contract or identification number	0805080HNO
Number of Individuals Covered	168
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $37,665
Welfare Benefit Premiums Paid to Carrier	USD $770,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,665
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE SERVICE

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

805080

Policy instance

Insurance contract or identification number	805080
Number of Individuals Covered	391
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $142,593
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,905,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $142,593
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE SERVICE

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	433
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $25,648
Total amount of fees paid to insurance company	USD $8,064
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $368,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,648
Amount paid for insurance broker fees	8064
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE SERVICE

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	512
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,329
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	LASIK, HEARING
Welfare Benefit Premiums Paid to Carrier	USD $43,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,204
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFIT INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	416
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $21,341
Total amount of fees paid to insurance company	USD $7,250
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $322,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,341
Amount paid for insurance broker fees	7250
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	435
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,388
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,388
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

805080

Policy instance

Insurance contract or identification number	805080
Number of Individuals Covered	391
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $121,239
Total amount of fees paid to insurance company	USD $16,100
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,635,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,573
Amount paid for insurance broker fees	16100
Additional information about fees paid to insurance broker	WEST JANUARY MEDICAL SUPERBONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE SERVICE

HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

805080

Policy instance

Insurance contract or identification number	805080
Number of Individuals Covered	117
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0805080HNO

Policy instance

Insurance contract or identification number	0805080HNO
Number of Individuals Covered	148
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $29,839
Welfare Benefit Premiums Paid to Carrier	USD $647,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,017
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE SERVICE

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

932432

Policy instance

Insurance contract or identification number	932432
Number of Individuals Covered	48
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $23,538
Total amount of fees paid to insurance company	USD $1,030
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $109,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,769
Amount paid for insurance broker fees	1030
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	82
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $659
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $659
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

932432

Policy instance

Insurance contract or identification number	932432
Number of Individuals Covered	47
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $24,564
Total amount of fees paid to insurance company	USD $1,074
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $131,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,282
Amount paid for insurance broker fees	1074
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

15194

Policy instance

Insurance contract or identification number	15194
Number of Individuals Covered	97
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to Carrier	USD $1,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-AD&D

Policy instance

Insurance contract or identification number	469777-AD&D
Number of Individuals Covered	367
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,356
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $15,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,356
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-DEATH

Policy instance

Insurance contract or identification number	469777-DEATH
Number of Individuals Covered	367
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $20,278
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,278
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

743259

Policy instance

Insurance contract or identification number	743259
Number of Individuals Covered	511
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $177,423
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,281,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $177,423
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	248
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $11,875
Total amount of fees paid to insurance company	USD $6,657
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $237,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,875
Amount paid for insurance broker fees	6657
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	BENEFITS ALLIANCE INSURANCE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	71
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $606
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $606
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	352
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,780
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,780
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-TERM

Policy instance

Insurance contract or identification number	469777-TERM
Number of Individuals Covered	384
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $39,442
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,442
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777

Policy instance

Insurance contract or identification number	469777
Number of Individuals Covered	384
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,282
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,282
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

932432

Policy instance

Insurance contract or identification number	932432
Number of Individuals Covered	54
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $24,844
Total amount of fees paid to insurance company	USD $777
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $124,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,422
Insurance broker organization code?	3
Amount paid for insurance broker fees	777
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION PAID
Insurance broker name	AGIS NETWORK INC

U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

15191

Policy instance

Insurance contract or identification number	15191
Number of Individuals Covered	109
Insurance policy start date	2012-08-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to Carrier	USD $817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

15191

Policy instance

Insurance contract or identification number	15191
Number of Individuals Covered	110
Insurance policy start date	2012-01-01
Insurance policy end date	2012-07-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PLAN
Welfare Benefit Premiums Paid to Carrier	USD $1,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-AD&D

Policy instance

Insurance contract or identification number	469777-AD&D
Number of Individuals Covered	384
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,595
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $15,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,595
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

743259

Policy instance

Insurance contract or identification number	743259
Number of Individuals Covered	568
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $155,677
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,380,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $155,677
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	272
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,393
Total amount of fees paid to insurance company	USD $7,203
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,851
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,393
Amount paid for insurance broker fees	7203
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	382
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,782
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,782
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	70
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $652
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $652
Insurance broker organization code?	3
Insurance broker name	WAYNE BLASMAN

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-AD&D

Policy instance

Insurance contract or identification number	469777-AD&D
Number of Individuals Covered	396
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $16,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-TERM

Policy instance

Insurance contract or identification number	469777-TERM
Number of Individuals Covered	396
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,824
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	61
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $551
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

US396254

Policy instance

Insurance contract or identification number	US396254
Number of Individuals Covered	273
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $26,045
Welfare Benefit Premiums Paid to Carrier	USD $523,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777-MED

Policy instance

Insurance contract or identification number	469777-MED
Number of Individuals Covered	456
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $133,998
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,695,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	306
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,757
Total amount of fees paid to insurance company	USD $7,482
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $235,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	385
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,678
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA EMPLOYEE ASSISTANCE PLAN (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777

Policy instance

Insurance contract or identification number	469777
Number of Individuals Covered	49
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )

Policy contract number

3208280

Policy instance

Insurance contract or identification number	3208280
Number of Individuals Covered	69
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $562
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $562
Insurance broker organization code?	3
Insurance broker name	WAYNE H. BLASMAN

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX961421

Policy instance

Insurance contract or identification number	FLX961421
Number of Individuals Covered	373
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $21,283
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,283
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-030087

Policy instance

Insurance contract or identification number	010-030087
Number of Individuals Covered	413
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,522
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,522
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFIT INS SERVICES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00421017

Policy instance

Insurance contract or identification number	00421017
Number of Individuals Covered	310
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,456
Total amount of fees paid to insurance company	USD $7,532
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $249,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $12,456
Amount paid for insurance broker fees	7532
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker name	WAYNE BLASMAN

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

469777

Policy instance

Insurance contract or identification number	469777
Number of Individuals Covered	484
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $128,147
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,570,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128,147
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

US396254

Policy instance

Insurance contract or identification number	US396254
Number of Individuals Covered	246
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $24,967
Welfare Benefit Premiums Paid to Carrier	USD $486,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,967
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 961518

Policy instance

Insurance contract or identification number	OK 961518
Number of Individuals Covered	373
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,509
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $16,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,509
Insurance broker organization code?	3
Insurance broker name	BRIDGEPORT BENEFITS INC

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Company Name:	ICE PARTNERS LLC
Employer identification number (EIN):	203612825
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	200529810025