EDGEWOOD VILLAGE MARKET, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN
401k plan membership statisitcs for EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN
Measure | Date | Value |
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2022: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-05-01 | 542 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 553 |
Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
Total of all active and inactive participants | 2022-05-01 | 553 |
Number of employers contributing to the scheme | 2022-05-01 | 0 |
2021: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-05-01 | 543 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 542 |
Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
Total of all active and inactive participants | 2021-05-01 | 542 |
Number of employers contributing to the scheme | 2021-05-01 | 0 |
2020: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-05-01 | 694 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 543 |
Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
Total of all active and inactive participants | 2020-05-01 | 543 |
Number of employers contributing to the scheme | 2020-05-01 | 0 |
2019: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-05-01 | 614 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 694 |
Number of retired or separated participants receiving benefits | 2019-05-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
Total of all active and inactive participants | 2019-05-01 | 699 |
Number of employers contributing to the scheme | 2019-05-01 | 0 |
2018: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-05-01 | 614 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 614 |
Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
Total of all active and inactive participants | 2018-05-01 | 614 |
Number of employers contributing to the scheme | 2018-05-01 | 0 |
2017: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-05-01 | 382 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 455 |
Number of retired or separated participants receiving benefits | 2017-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 0 |
Total of all active and inactive participants | 2017-05-01 | 459 |
2016: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-05-01 | 382 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 464 |
Number of retired or separated participants receiving benefits | 2016-05-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 0 |
Total of all active and inactive participants | 2016-05-01 | 465 |
2015: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-05-01 | 382 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 382 |
Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
Total of all active and inactive participants | 2015-05-01 | 382 |
2014: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-05-01 | 387 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 378 |
Number of retired or separated participants receiving benefits | 2014-05-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 0 |
Total of all active and inactive participants | 2014-05-01 | 382 |
2013: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-05-01 | 425 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 386 |
Number of retired or separated participants receiving benefits | 2013-05-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 0 |
Total of all active and inactive participants | 2013-05-01 | 387 |
2012: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-05-01 | 343 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 425 |
Total of all active and inactive participants | 2012-05-01 | 425 |
2011: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-05-01 | 338 |
Total of all active and inactive participants | 2011-05-01 | 0 |
2009: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-05-01 | 331 |
Total of all active and inactive participants | 2009-05-01 | 0 |
2022: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses |
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2022-05-01 | Type of plan entity | Single employer plan |
2022-05-01 | Plan funding arrangement – Insurance | Yes |
2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-05-01 | Plan benefit arrangement – Insurance | Yes |
2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses |
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2021-05-01 | Type of plan entity | Single employer plan |
2021-05-01 | Submission has been amended | Yes |
2021-05-01 | Plan funding arrangement – Insurance | Yes |
2021-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-05-01 | Plan benefit arrangement – Insurance | Yes |
2021-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses |
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2020-05-01 | Type of plan entity | Single employer plan |
2020-05-01 | Plan funding arrangement – Insurance | Yes |
2020-05-01 | Plan benefit arrangement – Insurance | Yes |
2019: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses |
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2019-05-01 | Type of plan entity | Single employer plan |
2019-05-01 | Submission has been amended | Yes |
2019-05-01 | Plan funding arrangement – Insurance | Yes |
2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-05-01 | Plan benefit arrangement – Insurance | Yes |
2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2018 form 5500 responses |
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2018-05-01 | Type of plan entity | Single employer plan |
2018-05-01 | Submission has been amended | Yes |
2018-05-01 | Plan funding arrangement – Insurance | Yes |
2018-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-05-01 | Plan benefit arrangement – Insurance | Yes |
2018-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2017 form 5500 responses |
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2017-05-01 | Type of plan entity | Single employer plan |
2017-05-01 | Submission has been amended | No |
2017-05-01 | This submission is the final filing | No |
2017-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-05-01 | Plan is a collectively bargained plan | No |
2017-05-01 | Plan funding arrangement – Insurance | Yes |
2017-05-01 | Plan benefit arrangement – Insurance | Yes |
2016: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2016 form 5500 responses |
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2016-05-01 | Type of plan entity | Single employer plan |
2016-05-01 | Submission has been amended | No |
2016-05-01 | This submission is the final filing | No |
2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-05-01 | Plan is a collectively bargained plan | No |
2016-05-01 | Plan funding arrangement – Insurance | Yes |
2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-05-01 | Plan benefit arrangement – Insurance | Yes |
2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2015 form 5500 responses |
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2015-05-01 | Type of plan entity | Single employer plan |
2015-05-01 | Submission has been amended | No |
2015-05-01 | This submission is the final filing | No |
2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-05-01 | Plan is a collectively bargained plan | No |
2015-05-01 | Plan funding arrangement – Insurance | Yes |
2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-05-01 | Plan benefit arrangement – Insurance | Yes |
2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2014 form 5500 responses |
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2014-05-01 | Type of plan entity | Single employer plan |
2014-05-01 | Submission has been amended | No |
2014-05-01 | This submission is the final filing | No |
2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-05-01 | Plan is a collectively bargained plan | No |
2014-05-01 | Plan funding arrangement – Insurance | Yes |
2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-05-01 | Plan benefit arrangement – Insurance | Yes |
2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2013 form 5500 responses |
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2013-05-01 | Type of plan entity | Single employer plan |
2013-05-01 | Submission has been amended | No |
2013-05-01 | This submission is the final filing | No |
2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-05-01 | Plan is a collectively bargained plan | No |
2013-05-01 | Plan funding arrangement – Insurance | Yes |
2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-05-01 | Plan benefit arrangement – Insurance | Yes |
2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2012 form 5500 responses |
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2012-05-01 | Type of plan entity | Single employer plan |
2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-05-01 | Plan benefit arrangement – Insurance | Yes |
2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2011 form 5500 responses |
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2011-05-01 | Type of plan entity | Single employer plan |
2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-05-01 | Plan benefit arrangement – Insurance | Yes |
2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: EDGEWOOD VILLAGE MARKET, INC. HEALTH & WELFARE PLAN 2009 form 5500 responses |
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2009-05-01 | Type of plan entity | Single employer plan |
2009-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-05-01 | Plan benefit arrangement – Insurance | Yes |
2009-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 5488270 |
Policy instance | 4 |
Insurance contract or identification number | 5488270 | Number of Individuals Covered | 57 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $2,479 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | HOSPITAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,479 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 930437 |
Policy instance | 3 |
Insurance contract or identification number | 930437 | Number of Individuals Covered | 102 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $3,027 | Total amount of fees paid to insurance company | USD $1,409 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $61,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,027 | Amount paid for insurance broker fees | 1409 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 62221 |
Policy instance | 2 |
Insurance contract or identification number | 62221 | Number of Individuals Covered | 553 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $5,527 | Total amount of fees paid to insurance company | USD $87 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $346,059 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,527 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3343522 |
Policy instance | 1 |
Insurance contract or identification number | 3343522 | Number of Individuals Covered | 390 | Insurance policy start date | 2022-05-01 | Insurance policy end date | 2023-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $200,640 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3343522 |
Policy instance | 1 |
Insurance contract or identification number | 3343522 | Number of Individuals Covered | 416 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $201,400 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 62221 |
Policy instance | 2 |
Insurance contract or identification number | 62221 | Number of Individuals Covered | 542 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $78 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $329,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 78 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 |
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AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 358528 |
Policy instance | 3 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 17 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $177 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | 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 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 930437 |
Policy instance | 4 |
Insurance contract or identification number | 930437 | Number of Individuals Covered | 121 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $2,882 | Total amount of fees paid to insurance company | USD $1,569 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $71,967 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,526 | Amount paid for insurance broker fees | 1569 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 5488270 |
Policy instance | 5 |
Insurance contract or identification number | 5488270 | Number of Individuals Covered | 67 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $2,912 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | HOSPITAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,912 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 358528 |
Policy instance | 6 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 371 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $2,857 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 2857 | Additional information about fees paid to insurance broker | OVERRIDE, NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 7 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 257 | Insurance policy start date | 2021-05-01 | Insurance policy end date | 2022-04-30 | Total amount of commissions paid to insurance broker | USD $2,604 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $10,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,372 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3343522 |
Policy instance | 1 |
Insurance contract or identification number | 3343522 | Number of Individuals Covered | 423 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $183,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 62221 |
Policy instance | 2 |
Insurance contract or identification number | 62221 | Number of Individuals Covered | 543 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $5,063 | Total amount of fees paid to insurance company | USD $106 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $314,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,063 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
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AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 358528 |
Policy instance | 3 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 18 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $106 | Total amount of fees paid to insurance company | USD $272 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $106 | Amount paid for insurance broker fees | 272 | Additional information about fees paid to insurance broker | OVERRIDE/NON-MONETARY COMMISSIONS | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 930437 |
Policy instance | 4 |
Insurance contract or identification number | 930437 | Number of Individuals Covered | 117 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $7,918 | Total amount of fees paid to insurance company | USD $3,299 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $78,946 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,918 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3299 | Additional information about fees paid to insurance broker | BONUS |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 5488270 |
Policy instance | 5 |
Insurance contract or identification number | 5488270 | Number of Individuals Covered | 80 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $3,512 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | HOSPITAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,512 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 358528 |
Policy instance | 6 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 409 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $2,677 | Total amount of fees paid to insurance company | USD $4,233 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,677 | Amount paid for insurance broker fees | 4233 | Additional information about fees paid to insurance broker | OVERRIDE/NON-MONETARY COMMISSIONS | Insurance broker organization code? | 3 |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 7 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 240 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $12,234 | Total amount of fees paid to insurance company | USD $7,854 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $9,181 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,234 | Amount paid for insurance broker fees | 7854 | Additional information about fees paid to insurance broker | OVERRIDE/NON-MONETARY COMMISSIONS | Insurance broker organization code? | 3 |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 8 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 472 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $141,320 | Total amount of fees paid to insurance company | USD $7,806 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $17,705 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $104,884 | Amount paid for insurance broker fees | 7806 | Additional information about fees paid to insurance broker | OVERRIDE NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 921518-001 |
Policy instance | 6 |
Insurance contract or identification number | 921518-001 | Number of Individuals Covered | 544 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $8,627 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $8,627 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 5488270 |
Policy instance | 5 |
Insurance contract or identification number | 5488270 | Number of Individuals Covered | 85 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $4,262 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | HOSPITAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $4,262 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 930437 |
Policy instance | 4 |
Insurance contract or identification number | 930437 | Number of Individuals Covered | 128 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $15,116 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $105,967 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,855 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 358528 |
Policy instance | 3 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 7 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $937 | Total amount of fees paid to insurance company | USD $42 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $937 | Amount paid for insurance broker fees | 42 | Additional information about fees paid to insurance broker | OVERRIDE NON-MONETARY COMMISSIONS | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 62221 |
Policy instance | 2 |
Insurance contract or identification number | 62221 | Number of Individuals Covered | 543 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $20,508 | Total amount of fees paid to insurance company | USD $9,810 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $300,178 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,837 | Amount paid for insurance broker fees | 8067 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 |
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UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
Policy contract number | 921518-002 |
Policy instance | 1 |
Insurance contract or identification number | 921518-002 | Number of Individuals Covered | 68 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $642 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $642 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 358528 |
Policy instance | 7 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 175 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $28,173 | Total amount of fees paid to insurance company | USD $1,010 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $20,292 | Amount paid for insurance broker fees | 1010 | Additional information about fees paid to insurance broker | OVERRIDE NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 330832 |
Policy instance | 1 |
Insurance contract or identification number | 330832 | Number of Individuals Covered | 614 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 9251518-199 |
Policy instance | 4 |
Insurance contract or identification number | 9251518-199 | Number of Individuals Covered | 528 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $16,867 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4262283 |
Policy instance | 3 |
Insurance contract or identification number | E4262283 | Number of Individuals Covered | 212 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $30,268 | Total amount of fees paid to insurance company | USD $6,867 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $158,654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,248 | Amount paid for insurance broker fees | 912 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 870073 |
Policy instance | 2 |
Insurance contract or identification number | 870073 | Number of Individuals Covered | 475 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $28,615 | Total amount of fees paid to insurance company | USD $6,555 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $272,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,615 | Amount paid for insurance broker fees | 6555 | Additional information about fees paid to insurance broker | DIRECT COMPENSATION INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 1 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 598 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $141,714 | Total amount of fees paid to insurance company | USD $6,611 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $141,714 | Amount paid for insurance broker fees | 6611 | Additional information about fees paid to insurance broker | OVERRIDE/NON-MONETARY COMMISSIONS | Insurance broker organization code? | 3 |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4262283 |
Policy instance | 4 |
Insurance contract or identification number | E4262283 | Number of Individuals Covered | 212 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $30,268 | Total amount of fees paid to insurance company | USD $6,867 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER | Welfare Benefit Premiums Paid to Carrier | USD $158,654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,248 | Amount paid for insurance broker fees | 912 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 870073 |
Policy instance | 3 |
Insurance contract or identification number | 870073 | Number of Individuals Covered | 475 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $28,615 | Total amount of fees paid to insurance company | USD $6,555 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $272,673 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,615 | Amount paid for insurance broker fees | 6555 | Additional information about fees paid to insurance broker | DIRECT AND INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
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UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 255757 |
Policy instance | 2 |
Insurance contract or identification number | 255757 | Number of Individuals Covered | 614 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4262283 |
Policy instance | 2 |
Insurance contract or identification number | E4262283 | Number of Individuals Covered | 277 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $57,591 | Total amount of fees paid to insurance company | USD $13,790 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY BENEFITS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $200,493 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57,591 | Amount paid for insurance broker fees | 13790 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | VARIOUS BROKERS |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0870073 |
Policy instance | 1 |
Insurance contract or identification number | 0870073 | Number of Individuals Covered | 676 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $34,750 | Total amount of fees paid to insurance company | USD $113,986 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,617,207 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,750 | Amount paid for insurance broker fees | 113986 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH & MCLENNAN |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751228 |
Policy instance | 1 |
Insurance contract or identification number | LK 751228 | Number of Individuals Covered | 375 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $6,505 | Total amount of fees paid to insurance company | USD $2,113 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $65,048 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,505 | Amount paid for insurance broker fees | 2113 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH MCLENNAN |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 6 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 289 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $59,972 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,277 | Insurance broker organization code? | 3 | Insurance broker name | KISTLER TIFFANY BENEFITS |
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UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
Policy contract number | 907133 |
Policy instance | 7 |
Insurance contract or identification number | 907133 | Number of Individuals Covered | 297 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $5,325 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $198,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,929 | Insurance broker organization code? | 3 | Insurance broker name | KISTLER TIFFANY BENEFITS |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 966557 |
Policy instance | 4 |
Insurance contract or identification number | OK 966557 | Number of Individuals Covered | 375 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $227 | Total amount of fees paid to insurance company | USD $81 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,472 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $227 | Amount paid for insurance broker fees | 81 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH MCLENNAN |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX 964949 |
Policy instance | 3 |
Insurance contract or identification number | FLX 964949 | Number of Individuals Covered | 375 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $5,988 | Total amount of fees paid to insurance company | USD $1,700 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $50,280 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,988 | Amount paid for insurance broker fees | 1700 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH MCLENNAN |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 963447 |
Policy instance | 2 |
Insurance contract or identification number | LK 963447 | Number of Individuals Covered | 312 | Insurance policy start date | 2014-09-01 | Insurance policy end date | 2015-08-31 | Total amount of commissions paid to insurance broker | USD $6,202 | Total amount of fees paid to insurance company | USD $2,046 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $62,021 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,202 | Amount paid for insurance broker fees | 2046 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH MCLENNAN |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4262283 |
Policy instance | 5 |
Insurance contract or identification number | E4262283 | Number of Individuals Covered | 136 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $14,815 | Total amount of fees paid to insurance company | USD $1,889 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY BENEFITS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $79,869 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,565 | Amount paid for insurance broker fees | 966 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LISA A PERRI |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E4262283 |
Policy instance | 6 |
Insurance contract or identification number | E4262283 | Number of Individuals Covered | 164 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $46,456 | Total amount of fees paid to insurance company | USD $13,252 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY BENEFITS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $75,844 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,825 | Amount paid for insurance broker fees | 8533 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL J PERRI |
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UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
Policy contract number | 907133 |
Policy instance | 5 |
Insurance contract or identification number | 907133 | Number of Individuals Covered | 296 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $212,886 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX 964949 |
Policy instance | 4 |
Insurance contract or identification number | FLX 964949 | Number of Individuals Covered | 391 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $7,633 | Total amount of fees paid to insurance company | USD $294 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $52,632 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,647 | Amount paid for insurance broker fees | 294 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING, INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751228 |
Policy instance | 3 |
Insurance contract or identification number | LK 751228 | Number of Individuals Covered | 389 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $8,862 | Total amount of fees paid to insurance company | USD $346 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $64,481 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,475 | Amount paid for insurance broker fees | 346 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING, INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 966557 |
Policy instance | 2 |
Insurance contract or identification number | OK 966557 | Number of Individuals Covered | 391 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $340 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,474 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $247 | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 963447 |
Policy instance | 1 |
Insurance contract or identification number | LK 963447 | Number of Individuals Covered | 336 | Insurance policy start date | 2013-09-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $8,893 | Total amount of fees paid to insurance company | USD $353 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $64,381 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,461 | Amount paid for insurance broker fees | 353 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING INC. |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 358528 |
Policy instance | 7 |
Insurance contract or identification number | 358528 | Number of Individuals Covered | 280 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $91,668 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $91,668 | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH & MCLENNAN |
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HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 1808140000 |
Policy instance | 1 |
Insurance contract or identification number | 1808140000 | Number of Individuals Covered | 533 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $77,861 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,594,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $77,861 | Insurance broker organization code? | 3 | Insurance broker name | ERC MODEL CONSULTING INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX 964949 |
Policy instance | 7 |
Insurance contract or identification number | FLX 964949 | Number of Individuals Covered | 386 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $7,271 | Total amount of fees paid to insurance company | USD $1,063 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $48,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,271 | Amount paid for insurance broker fees | 1063 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING, INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751228 |
Policy instance | 6 |
Insurance contract or identification number | LK 751228 | Number of Individuals Covered | 381 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $8,622 | Total amount of fees paid to insurance company | USD $993 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $57,480 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,622 | Amount paid for insurance broker fees | 993 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING, INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 966557 |
Policy instance | 5 |
Insurance contract or identification number | OK 966557 | Number of Individuals Covered | 386 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $342 | Total amount of fees paid to insurance company | USD $39 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,282 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $342 | Amount paid for insurance broker fees | 39 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING INC. |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 963447 |
Policy instance | 4 |
Insurance contract or identification number | LK 963447 | Number of Individuals Covered | 332 | Insurance policy start date | 2012-09-01 | Insurance policy end date | 2013-08-31 | Total amount of commissions paid to insurance broker | USD $8,923 | Total amount of fees paid to insurance company | USD $1,577 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $59,487 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,923 | Amount paid for insurance broker fees | 1577 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING INC. |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 10888000 |
Policy instance | 3 |
Insurance contract or identification number | 10888000 | Number of Individuals Covered | 279 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $7,003 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY BENEFITS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $84,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,003 | Insurance broker organization code? | 3 | Insurance broker name | TRION GROUP, A MARSH MCLENNAN |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05992372 |
Policy instance | 2 |
Insurance contract or identification number | TM05992372 | Number of Individuals Covered | 675 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $7,848 | Total amount of fees paid to insurance company | USD $1,145 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $175,352 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,547 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1145 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker name | NFP INS SERVICES INC. |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05992372 |
Policy instance | 3 |
Insurance contract or identification number | TM05992372 | Number of Individuals Covered | 681 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $6,281 | Total amount of fees paid to insurance company | USD $11 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,281 | Amount paid for insurance broker fees | 11 | Additional information about fees paid to insurance broker | SALES | Insurance broker organization code? | 3 | Insurance broker name | MODEL CONSULTING INC |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 10888000 |
Policy instance | 1 |
Insurance contract or identification number | 10888000 | Number of Individuals Covered | 249 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $6,363 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,666 | Additional information about fees paid to insurance broker | SALES | Insurance broker organization code? | 3 | Insurance broker name | CORE BENEFITS SOLUTIONS, LLC |
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HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 1808140000 |
Policy instance | 2 |
Insurance contract or identification number | 1808140000 | Number of Individuals Covered | 544 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $109,738 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $109,738 | Additional information about fees paid to insurance broker | SALES | Insurance broker organization code? | 3 | Insurance broker name | ERC MODEL INSURANCE COMPANY |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SDJ960325 |
Policy instance | 4 |
Insurance contract or identification number | SDJ960325 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $24,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,180 | Additional information about fees paid to insurance broker | SALES | Insurance broker organization code? | 3 | Insurance broker name | MODELING CONSULTING |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 08101 |
Policy instance | 4 |
Insurance contract or identification number | 08101 | Number of Individuals Covered | 259 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $36,821 | Total amount of fees paid to insurance company | USD $120 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | |
Policy instance | 3 |
Number of Individuals Covered | 164 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $9,093 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | |
Policy instance | 2 |
Number of Individuals Covered | 252 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $5,788 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 612506 |
Policy instance | 1 |
Insurance contract or identification number | 612506 | Number of Individuals Covered | 485 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $95,102 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 612506 |
Policy instance | 3 |
Insurance contract or identification number | 612506 | Number of Individuals Covered | 2 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $1,035 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05732418 |
Policy instance | 2 |
Insurance contract or identification number | TM05732418 | Number of Individuals Covered | 606 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $6,141 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 427871 |
Policy instance | 4 |
Insurance contract or identification number | 427871 | Number of Individuals Covered | 21 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $9,099 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010042228 |
Policy instance | 5 |
Insurance contract or identification number | 000010042228 | Number of Individuals Covered | 337 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $981 | Life 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 |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | |
Policy instance | 6 |
Number of Individuals Covered | 169 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $9,540 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 08101 |
Policy instance | 7 |
Insurance contract or identification number | 08101 | Number of Individuals Covered | 337 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $20,047 | Total amount of fees paid to insurance company | USD $1,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 427771 |
Policy instance | 1 |
Insurance contract or identification number | 427771 | Number of Individuals Covered | 237 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $129,686 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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