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HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 401k Plan overview

Plan NameHEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN
Plan identification number 502

HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HEFREN-TILLOTSON, INC. has sponsored the creation of one or more 401k plans.

Company Name:HEFREN-TILLOTSON, INC.
Employer identification number (EIN):251121408
NAIC Classification:523900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-07-01
5022021-07-01
5022020-07-01
5022019-07-01
5022018-07-01
5022017-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2019-02-25
5022016-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2018-02-13
5022015-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2017-04-17
5022014-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2016-03-29
5022013-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2015-04-02
5022012-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2014-06-09
5022011-07-01JOSEPH NIESSLEIN JOSEPH NIESSLEIN2013-03-05
5022009-07-01JOSEPH NIESSLEIN

Plan Statistics for HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN

401k plan membership statisitcs for HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN

Measure Date Value
2022: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01246
Total number of active participants reported on line 7a of the Form 55002022-07-010
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-010
2021: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01246
Total number of active participants reported on line 7a of the Form 55002021-07-01246
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01246
2020: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01250
Total number of active participants reported on line 7a of the Form 55002020-07-010
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-01246
Total of all active and inactive participants2020-07-01246
2019: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01234
Total number of active participants reported on line 7a of the Form 55002019-07-01250
Total of all active and inactive participants2019-07-01250
2018: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01227
Total number of active participants reported on line 7a of the Form 55002018-07-01234
Total of all active and inactive participants2018-07-01234
2017: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01211
Total number of active participants reported on line 7a of the Form 55002017-07-01227
Total of all active and inactive participants2017-07-01227
2016: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01207
Total number of active participants reported on line 7a of the Form 55002016-07-01211
Total of all active and inactive participants2016-07-01211
2015: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01194
Total number of active participants reported on line 7a of the Form 55002015-07-01207
Total of all active and inactive participants2015-07-01207
2014: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01176
Total number of active participants reported on line 7a of the Form 55002014-07-01194
Total of all active and inactive participants2014-07-01194
2013: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01166
Total number of active participants reported on line 7a of the Form 55002013-07-01176
Total of all active and inactive participants2013-07-01176
2012: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01154
Total number of active participants reported on line 7a of the Form 55002012-07-01166
Total of all active and inactive participants2012-07-01166
2011: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01144
Total number of active participants reported on line 7a of the Form 55002011-07-01154
Total of all active and inactive participants2011-07-01154
2009: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01139
Total number of active participants reported on line 7a of the Form 55002009-07-01144
Total of all active and inactive participants2009-07-01144
Total participants2009-07-010

Form 5500 Responses for HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN

2022: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingYes
2022-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedYes
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: HEFREN-TILLOTSON, INC. SECTION 125 CAFETERIA PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 6
Insurance contract or identification numberSGM602430
Number of Individuals Covered0
Insurance policy start date2022-04-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $3,323
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,323
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered0
Insurance policy start date2022-03-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,400
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,400
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 2
Insurance contract or identification numberCI960015
Number of Individuals Covered0
Insurance policy start date2022-07-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $572
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $572
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946-SL
Policy instance 3
Insurance contract or identification number0865946-SL
Number of Individuals Covered0
Insurance policy start date2022-07-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $92,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 4
Insurance contract or identification numberSGD602348
Number of Individuals Covered0
Insurance policy start date2022-03-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $3,064
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,064
Insurance broker organization code?3
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 7
Insurance contract or identification number01285176
Number of Individuals Covered0
Insurance policy start date2022-07-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $224
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $224
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 8
Insurance contract or identification number0865946
Number of Individuals Covered0
Insurance policy start date2022-07-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $2,321
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,321
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 5
Insurance contract or identification numberSOK601494
Number of Individuals Covered0
Insurance policy start date2022-03-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,102
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,102
Insurance broker organization code?3
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 7
Insurance contract or identification number01285176
Number of Individuals Covered223
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $767
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $767
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 6
Insurance contract or identification numberSGM602430
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $5,835
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,835
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 5
Insurance contract or identification numberSOK601494
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $1,223
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $12,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,223
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 4
Insurance contract or identification numberSGD602348
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $1,140
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,140
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 8
Insurance contract or identification number0865946
Number of Individuals Covered361
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $5,585
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,585
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946-SL
Policy instance 3
Insurance contract or identification number0865946-SL
Number of Individuals Covered210
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $294,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 2
Insurance contract or identification numberCI960015
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,717
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $11,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,717
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $1,414
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,414
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 3
Insurance contract or identification numberSGD602348
Number of Individuals Covered246
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $4,344
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,344
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 7
Insurance contract or identification number0865946
Number of Individuals Covered357
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,771
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,771
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered92
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $2,514
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,514
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 4
Insurance contract or identification numberSOK601494
Number of Individuals Covered314
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $1,792
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $12,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,792
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 5
Insurance contract or identification numberSGM602430
Number of Individuals Covered368
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $5,914
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $118,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,914
Insurance broker organization code?3
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 6
Insurance contract or identification number01285176
Number of Individuals Covered421
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $738
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $738
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 8
Insurance contract or identification numberCI960015
Number of Individuals Covered33
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,691
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $11,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,691
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946-SL
Policy instance 2
Insurance contract or identification number0865946-SL
Number of Individuals Covered208
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $271,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 6
Insurance contract or identification number01285176
Number of Individuals Covered403
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $697
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $697
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 5
Insurance contract or identification numberSGM602430
Number of Individuals Covered301
Insurance policy start date2019-04-01
Insurance policy end date2020-04-01
Total amount of commissions paid to insurance brokerUSD $5,291
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,291
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 4
Insurance contract or identification numberSOK601494
Number of Individuals Covered295
Insurance policy start date2019-04-01
Insurance policy end date2020-04-01
Total amount of commissions paid to insurance brokerUSD $1,721
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $12,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,721
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 3
Insurance contract or identification numberSGD602348
Number of Individuals Covered250
Insurance policy start date2019-04-01
Insurance policy end date2020-04-01
Total amount of commissions paid to insurance brokerUSD $4,237
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,237
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946-SL
Policy instance 2
Insurance contract or identification number0865946-SL
Number of Individuals Covered203
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Welfare Benefit Premiums Paid to CarrierUSD $235,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered90
Insurance policy start date2019-04-01
Insurance policy end date2020-04-01
Total amount of commissions paid to insurance brokerUSD $2,413
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,413
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 7
Insurance contract or identification number0865946
Number of Individuals Covered315
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,854
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,854
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 8
Insurance contract or identification numberCI960015
Number of Individuals Covered28
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $1,305
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $8,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,305
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered87
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $2,346
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,346
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 7
Insurance contract or identification numberCI960015
Number of Individuals Covered23
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $915
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $6,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $915
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 6
Insurance contract or identification number0865946
Number of Individuals Covered350
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $4,452
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,898,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,452
Insurance broker organization code?3
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered397
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $678
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $678
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered276
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $4,572
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,572
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered277
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $1,657
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $11,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,657
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered234
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $4,101
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,101
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 7
Insurance contract or identification numberCI960015
Number of Individuals Covered21
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $1,218
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $8,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 6
Insurance contract or identification number0865946
Number of Individuals Covered327
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $4,134
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,822,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered370
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $631
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered268
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $4,064
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered267
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $1,517
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $10,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered227
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $3,832
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered84
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $1,904
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000,-070
Policy instance 9
Insurance contract or identification number253499-000,-070
Number of Individuals Covered52
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 7
Insurance contract or identification numberCI960015
Number of Individuals Covered19
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $755
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $5,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $755
Insurance broker organization code?3
Insurance broker nameBABB INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 6
Insurance contract or identification number0865946
Number of Individuals Covered324
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,399,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered359
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $611
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $611
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered298
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $3,685
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,685
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered264
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $1,489
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $9,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,489
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered207
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $3,710
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,710
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered63
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $1,577
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,577
Insurance broker organization code?3
Insurance broker nameBABB INC
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000,-099
Policy instance 8
Insurance contract or identification number838142-000,-099
Number of Individuals Covered252
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $7,089
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,089
Insurance broker organization code?3
Insurance broker nameBABB INC
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000,-070
Policy instance 9
Insurance contract or identification number253499-000,-070
Number of Individuals Covered56
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered335
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $580
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $580
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 7
Insurance contract or identification numberCI960015
Number of Individuals Covered19
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $755
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $5,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $755
Insurance broker organization code?3
Insurance broker nameBABB INC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0865946
Policy instance 6
Insurance contract or identification number0865946
Number of Individuals Covered300
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $37,544
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,214,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,544
Insurance broker organization code?3
Insurance broker nameBABB INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered229
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $3,953
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,953
Insurance broker organization code?3
Insurance broker nameBABB INC
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000,-099
Policy instance 8
Insurance contract or identification number838142-000,-099
Number of Individuals Covered224
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $7,109
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,109
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered231
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $1,530
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $10,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,530
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered63
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $2,246
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,246
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered194
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $3,797
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,797
Insurance broker organization code?3
Insurance broker nameBABB INC
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000,-070
Policy instance 8
Insurance contract or identification number253499-000,-070
Number of Individuals Covered55
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000,-099
Policy instance 7
Insurance contract or identification number838142-000,-099
Number of Individuals Covered206
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,668
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,668
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI960015
Policy instance 6
Insurance contract or identification numberCI960015
Number of Individuals Covered14
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $530
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $3,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $530
Insurance broker organization code?3
Insurance broker nameBABB INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered318
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $22,135
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,101,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,135
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered199
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $1,235
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $8,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,235
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered176
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $3,121
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,121
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered61
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $1,304
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,304
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered193
Insurance policy start date2013-04-01
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $3,056
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,056
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered154
Insurance policy start date2012-04-01
Insurance policy end date2013-04-01
Total amount of commissions paid to insurance brokerUSD $2,848
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,225
Amount paid for insurance broker fees460
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered78
Insurance policy start date2012-04-01
Insurance policy end date2013-04-01
Total amount of commissions paid to insurance brokerUSD $963
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,223
Amount paid for insurance broker fees115
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered154
Insurance policy start date2012-04-01
Insurance policy end date2013-04-01
Total amount of commissions paid to insurance brokerUSD $3,034
Total amount of fees paid to insurance companyUSD $843
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $60,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,034
Amount paid for insurance broker fees843
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBABB INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285176
Policy instance 5
Insurance contract or identification number01285176
Number of Individuals Covered302
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $21,233
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,055,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,233
Insurance broker organization code?3
Insurance broker nameBABB INC
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000,-070
Policy instance 7
Insurance contract or identification number253499-000,-070
Number of Individuals Covered54
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000,-099
Policy instance 6
Insurance contract or identification number838142-000,-099
Number of Individuals Covered170
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $5,128
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,048
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered50
Insurance policy start date2012-04-01
Insurance policy end date2013-04-01
Total amount of commissions paid to insurance brokerUSD $1,178
Total amount of fees paid to insurance companyUSD $206
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,178
Amount paid for insurance broker fees206
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBABB INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT600475
Policy instance 1
Insurance contract or identification numberVDT600475
Number of Individuals Covered50
Insurance policy start date2011-04-01
Insurance policy end date2012-04-01
Total amount of commissions paid to insurance brokerUSD $873
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD602348
Policy instance 2
Insurance contract or identification numberSGD602348
Number of Individuals Covered154
Insurance policy start date2011-04-01
Insurance policy end date2012-04-01
Total amount of commissions paid to insurance brokerUSD $2,848
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01285102
Policy instance 5
Insurance contract or identification number01285102
Number of Individuals Covered291
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $21,090
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,040,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000,-070
Policy instance 7
Insurance contract or identification number253499-000,-070
Number of Individuals Covered54
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000,-099
Policy instance 6
Insurance contract or identification number838142-000,-099
Number of Individuals Covered170
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $5,128
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM602430
Policy instance 4
Insurance contract or identification numberSGM602430
Number of Individuals Covered183
Insurance policy start date2011-04-01
Insurance policy end date2012-04-01
Total amount of commissions paid to insurance brokerUSD $2,482
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK601494
Policy instance 3
Insurance contract or identification numberSOK601494
Number of Individuals Covered78
Insurance policy start date2011-04-01
Insurance policy end date2012-04-01
Total amount of commissions paid to insurance brokerUSD $963
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number253499-000-070
Policy instance 5
Insurance contract or identification number253499-000-070
Number of Individuals Covered31
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,786
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number012851 AND SUBS
Policy instance 3
Insurance contract or identification number012851 AND SUBS
Number of Individuals Covered132
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $18,498
Welfare Benefit Premiums Paid to CarrierUSD $913,729
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number124593
Policy instance 2
Insurance contract or identification number124593
Number of Individuals Covered144
Insurance policy start date2010-07-01
Insurance policy end date2011-03-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number080906-00
Policy instance 1
Insurance contract or identification number080906-00
Number of Individuals Covered131
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $18,030
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,030
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number838142-000-099
Policy instance 4
Insurance contract or identification number838142-000-099
Number of Individuals Covered77
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,724
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,760

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