CALIFORNIA DENTAL HYGIENISTS ASSOCIATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE
401k plan membership statisitcs for CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE
| Measure | Date | Value |
|---|
| 2022: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 329 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 316 |
| Total of all active and inactive participants | 2022-07-01 | 316 |
| Total participants | 2022-07-01 | 316 |
| 2021: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 358 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 329 |
| Total of all active and inactive participants | 2021-07-01 | 329 |
| Total participants | 2021-07-01 | 329 |
| Number of employers contributing to the scheme | 2021-07-01 | 0 |
| 2020: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 414 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 358 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 358 |
| Total participants | 2020-07-01 | 358 |
| Number of employers contributing to the scheme | 2020-07-01 | 0 |
| 2019: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 453 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 414 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 414 |
| Total participants | 2019-07-01 | 414 |
| Number of employers contributing to the scheme | 2019-07-01 | 0 |
| 2018: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 343 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 453 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
| Total of all active and inactive participants | 2018-07-01 | 453 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-07-01 | 0 |
| Total participants | 2018-07-01 | 453 |
| Number of participants with account balances | 2018-07-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-07-01 | 0 |
| Number of employers contributing to the scheme | 2018-07-01 | 0 |
| 2017: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 289 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 343 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
| Total of all active and inactive participants | 2017-07-01 | 343 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-07-01 | 0 |
| Total participants | 2017-07-01 | 343 |
| Number of participants with account balances | 2017-07-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-07-01 | 0 |
| Number of employers contributing to the scheme | 2017-07-01 | 0 |
| Measure | Date | Value |
|---|
| 2018 : CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-06-30 | $0 |
| Total transfer of assets to this plan | 2018-06-30 | $0 |
| Total transfer of assets from this plan | 2018-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $0 |
| Total income from all sources (including contributions) | 2018-06-30 | $412,053 |
| Total loss/gain on sale of assets | 2018-06-30 | $0 |
| Total of all expenses incurred | 2018-06-30 | $383,901 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $283,112 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $412,053 |
| Value of total assets at end of year | 2018-06-30 | $28,202 |
| Value of total assets at beginning of year | 2018-06-30 | $50 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $100,789 |
| Total interest from all sources | 2018-06-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-06-30 | $0 |
| Assets. Real estate other than employer real property at end of year | 2018-06-30 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2018-06-30 | $0 |
| Administrative expenses professional fees incurred | 2018-06-30 | $23,244 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2018-06-30 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2018-06-30 | $0 |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Contributions received from participants | 2018-06-30 | $412,053 |
| Participant contributions at end of year | 2018-06-30 | $0 |
| Participant contributions at beginning of year | 2018-06-30 | $0 |
| Participant contributions at end of year | 2018-06-30 | $0 |
| Participant contributions at beginning of year | 2018-06-30 | $0 |
| Assets. Other investments not covered elsewhere at end of year | 2018-06-30 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2018-06-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-06-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-06-30 | $0 |
| Assets. Loans (other than to participants) at end of year | 2018-06-30 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2018-06-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-06-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-06-30 | $0 |
| Administrative expenses (other) incurred | 2018-06-30 | $23,647 |
| Liabilities. Value of operating payables at end of year | 2018-06-30 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2018-06-30 | $0 |
| Total non interest bearing cash at end of year | 2018-06-30 | $28,202 |
| Total non interest bearing cash at beginning of year | 2018-06-30 | $50 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $28,152 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $28,202 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $50 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2018-06-30 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2018-06-30 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-06-30 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-06-30 | $0 |
| Value of interest in pooled separate accounts at end of year | 2018-06-30 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2018-06-30 | $0 |
| Value of interest in master investment trust accounts at end of year | 2018-06-30 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2018-06-30 | $0 |
| Value of interest in common/collective trusts at end of year | 2018-06-30 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2018-06-30 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-06-30 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-06-30 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-06-30 | $0 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2018-06-30 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2018-06-30 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2018-06-30 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2018-06-30 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $283,112 |
| Asset value of US Government securities at end of year | 2018-06-30 | $0 |
| Asset value of US Government securities at beginning of year | 2018-06-30 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Assets. Invements in employer securities at end of year | 2018-06-30 | $0 |
| Assets. Invements in employer securities at beginning of year | 2018-06-30 | $0 |
| Assets. Value of employer real property at end of year | 2018-06-30 | $0 |
| Assets. Value of employer real property at beginning of year | 2018-06-30 | $0 |
| Employer contributions (assets) at end of year | 2018-06-30 | $0 |
| Employer contributions (assets) at beginning of year | 2018-06-30 | $0 |
| Asset. Corporate debt instrument preferred debt at end of year | 2018-06-30 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2018-06-30 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2018-06-30 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2018-06-30 | $0 |
| Contract administrator fees | 2018-06-30 | $53,898 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2018-06-30 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2018-06-30 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2018-06-30 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-06-30 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-06-30 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-06-30 | $0 |
| Did the plan have assets held for investment | 2018-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Liabilities. Value of acquisition indebtedness at end of year | 2018-06-30 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2018-06-30 | $0 |
| 2022: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Submission has been amended | No |
| 2022-07-01 | This submission is the final filing | No |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-07-01 | Plan is a collectively bargained plan | No |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | No |
| 2020-07-01 | This submission is the final filing | No |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-07-01 | Plan is a collectively bargained plan | No |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Submission has been amended | No |
| 2019-07-01 | This submission is the final filing | No |
| 2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-07-01 | Plan is a collectively bargained plan | No |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: CALIFORNIA DENTAL HYGIENISTS ASSOCIATION GROUP INSURANCE 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | First time form 5500 has been submitted | Yes |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1112834 |
| Policy instance | 2 |
| Insurance contract or identification number | 1112834 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $4,213 | | 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 | 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 $28,071 | | Commission paid to Insurance Broker | USD $1,053 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58631 |
| Policy instance | 1 |
| Insurance contract or identification number | 58631 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $75,821 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $1,432 | | Additional information about fees paid to insurance broker | ENROLLER | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1112834 |
| Policy instance | 2 |
| Insurance contract or identification number | 1112834 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $3,981 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $26,545 | | Commission paid to Insurance Broker | USD $995 | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58631 |
| Policy instance | 1 |
| Insurance contract or identification number | 58631 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $63,847 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $14,907 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1112834 |
| Policy instance | 2 |
| Insurance contract or identification number | 1112834 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $4,335 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $28,918 | | Commission paid to Insurance Broker | USD $1,084 | | Additional information about fees paid to insurance broker | INSURANCE AGENT OR BROKER | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58631 |
| Policy instance | 1 |
| Insurance contract or identification number | 58631 | | Number of Individuals Covered | 351 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $129,669 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $30,364 | | Amount paid for insurance broker fees | 30364 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1112834 |
| Policy instance | 2 |
| Insurance contract or identification number | 1112834 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $3,793 | | Total amount of fees paid to insurance company | USD $0 | | 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 | 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 $23,312 | | Commission paid to Insurance Broker | USD $1,896 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS | | Insurance broker organization code? | 3 |
|
| AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
| Policy contract number | 58631 |
| Policy instance | 1 |
| Insurance contract or identification number | 58631 | | Number of Individuals Covered | 335 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $199,802 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $37,288 | | Amount paid for insurance broker fees | 37288 | | Additional information about fees paid to insurance broker | ENROLLER | | Insurance broker organization code? | 3 |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-017358-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 01-017358-00 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $38,124 | | Total amount of fees paid to insurance company | USD $8,795 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | 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 $9,531 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NA | | Insurance broker organization code? | 3 |
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-017358-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 01-017358-00 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $42,467 | | Total amount of fees paid to insurance company | USD $6,742 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | 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 |
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