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SNP PHARMACY MEDICAL PLAN 401k Plan overview

Plan NameSNP PHARMACY MEDICAL PLAN
Plan identification number 501

SNP PHARMACY MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance

401k Sponsoring company profile

SKILLED NURSING PHARMACY INC has sponsored the creation of one or more 401k plans.

Company Name:SKILLED NURSING PHARMACY INC
Employer identification number (EIN):330940254
NAIC Classification:325410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SNP PHARMACY MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01BEN MANDELBAUM BEN MANDELBAUM2018-07-16
5012016-01-01BEN MANDELBAUM BEN MANDELBAUM2017-07-31
5012015-01-01BEN MANDELBAUM BEN MANDELBAUM2016-09-26
5012014-01-01BEN MANDELBAUM BEN MANDELBAUM2015-08-11
5012013-01-01BEN MANDELBAUM BEN MANDELBAUM2014-08-11
5012012-01-01BEN MANDELBAUM BEN MANDELBAUM2013-07-31
5012011-01-01BEN MANDELBAUM BEN MANDELBAUM2012-08-07
5012010-01-01BEN MANDELBAUM BEN MANDELBAUM2011-10-19
5012009-01-01BEN MANDELBAUM BEN MANDELBAUM2011-10-17
5012009-01-01BEN MANDELBAUM BEN MANDELBAUM2011-10-18

Plan Statistics for SNP PHARMACY MEDICAL PLAN

401k plan membership statisitcs for SNP PHARMACY MEDICAL PLAN

Measure Date Value
2022: SNP PHARMACY MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01314
Total number of active participants reported on line 7a of the Form 55002022-01-01268
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01268
2021: SNP PHARMACY MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01157
Total number of active participants reported on line 7a of the Form 55002021-01-01314
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01314
2020: SNP PHARMACY MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01189
Total number of active participants reported on line 7a of the Form 55002020-01-01157
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01157
2019: SNP PHARMACY MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01286
Total number of active participants reported on line 7a of the Form 55002019-01-01189
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01189
2018: SNP PHARMACY MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01278
Total number of active participants reported on line 7a of the Form 55002018-01-01286
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01286
2017: SNP PHARMACY MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01278
Total number of active participants reported on line 7a of the Form 55002017-01-01278
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01279
2016: SNP PHARMACY MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01201
Total number of active participants reported on line 7a of the Form 55002016-01-01278
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01279
2015: SNP PHARMACY MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01253
Total number of active participants reported on line 7a of the Form 55002015-01-01201
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01201
2014: SNP PHARMACY MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01307
Total number of active participants reported on line 7a of the Form 55002014-01-01253
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01253
2013: SNP PHARMACY MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01229
Total number of active participants reported on line 7a of the Form 55002013-01-01307
Total of all active and inactive participants2013-01-01307
2012: SNP PHARMACY MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01236
Total number of active participants reported on line 7a of the Form 55002012-01-01229
Total of all active and inactive participants2012-01-01229
2011: SNP PHARMACY MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01107
Total number of active participants reported on line 7a of the Form 55002011-01-01239
Total of all active and inactive participants2011-01-01239
2010: SNP PHARMACY MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01302
Total number of active participants reported on line 7a of the Form 55002010-01-01448
Total of all active and inactive participants2010-01-01448
2009: SNP PHARMACY MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01151
Total number of active participants reported on line 7a of the Form 55002009-01-01292
Total of all active and inactive participants2009-01-01292

Form 5500 Responses for SNP PHARMACY MEDICAL PLAN

2022: SNP PHARMACY MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: SNP PHARMACY MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SNP PHARMACY MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: SNP PHARMACY MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: SNP PHARMACY MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: SNP PHARMACY MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: SNP PHARMACY MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SNP PHARMACY MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: SNP PHARMACY MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SNP PHARMACY MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SNP PHARMACY MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SNP PHARMACY MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: SNP PHARMACY MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: SNP PHARMACY MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberL03117
Policy instance 4
Insurance contract or identification numberL03117
Number of Individuals Covered163
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $13,892
Total amount of fees paid to insurance companyUSD $13,892
Welfare Benefit Premiums Paid to CarrierUSD $767,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,892
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
Amount paid for insurance broker fees13892
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberL03117
Policy instance 3
Insurance contract or identification numberL03117
Number of Individuals Covered21
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,630
Total amount of fees paid to insurance companyUSD $1,630
Welfare Benefit Premiums Paid to CarrierUSD $90,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,630
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
Amount paid for insurance broker fees1630
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered18
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $2,718
Welfare Benefit Premiums Paid to CarrierUSD $142,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,718
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 1
Insurance contract or identification number121894
Number of Individuals Covered118
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $20,937
Welfare Benefit Premiums Paid to CarrierUSD $1,083,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,937
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 1
Insurance contract or identification number121894
Number of Individuals Covered162
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $20,335
Welfare Benefit Premiums Paid to CarrierUSD $1,022,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,335
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered23
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $3,482
Welfare Benefit Premiums Paid to CarrierUSD $172,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,482
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0064765
Policy instance 3
Insurance contract or identification numberW0064765
Number of Individuals Covered137
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of fees paid to insurance companyUSD $38,362
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $943,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees19471
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0064765
Policy instance 3
Insurance contract or identification numberW0064765
Number of Individuals Covered198
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $1,835
Total amount of fees paid to insurance companyUSD $29,722
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $747,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,835
Amount paid for insurance broker fees14488
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered24
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $2,627
Welfare Benefit Premiums Paid to CarrierUSD $120,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,627
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 1
Insurance contract or identification number121894
Number of Individuals Covered183
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $21,665
Welfare Benefit Premiums Paid to CarrierUSD $1,086,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,665
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 1
Insurance contract or identification number121894
Number of Individuals Covered189
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $22,796
Welfare Benefit Premiums Paid to CarrierUSD $1,082,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,796
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered36
Insurance policy start date2018-06-01
Insurance policy end date2019-05-30
Total amount of commissions paid to insurance brokerUSD $4,784
Welfare Benefit Premiums Paid to CarrierUSD $218,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,784
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0064765
Policy instance 3
Insurance contract or identification numberW0064765
Number of Individuals Covered201
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $37,421
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $942,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,184
Insurance broker organization code?3
Additional information about fees paid to insurance brokerGENERAL AGENT SERVICES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered81
Insurance policy start date2016-06-01
Insurance policy end date2017-05-31
Total amount of commissions paid to insurance brokerUSD $9,244
Welfare Benefit Premiums Paid to CarrierUSD $374,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,244
Insurance broker organization code?3
Insurance broker nameMARVIN INSURANCE SERVICES LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 1
Insurance contract or identification number121894
Number of Individuals Covered327
Insurance policy start date2016-06-01
Insurance policy end date2017-05-31
Total amount of commissions paid to insurance brokerUSD $36,253
Welfare Benefit Premiums Paid to CarrierUSD $1,429,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,253
Insurance broker organization code?3
Insurance broker nameMARVIN INSURANCE SERVICES LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 6
Insurance contract or identification number658833
Number of Individuals Covered73
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $7,456
Welfare Benefit Premiums Paid to CarrierUSD $295,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,456
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 5
Insurance contract or identification number121894
Number of Individuals Covered287
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $30,464
Welfare Benefit Premiums Paid to CarrierUSD $1,224,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,464
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG843
Policy instance 4
Insurance contract or identification numberBG843
Number of Individuals Covered21
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,060
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,174
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG842
Policy instance 3
Insurance contract or identification numberBG842
Number of Individuals Covered24
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,315
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $582
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG841
Policy instance 2
Insurance contract or identification numberBG841
Number of Individuals Covered4
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $214
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58
Insurance broker organization code?3
Insurance broker nameARLENE MONTANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered79
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,962
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,281
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered90
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,444
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,866
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG841
Policy instance 2
Insurance contract or identification numberBG841
Number of Individuals Covered7
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $607
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $321
Insurance broker organization code?3
Insurance broker nameARLENE MONTANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG842
Policy instance 3
Insurance contract or identification numberBG842
Number of Individuals Covered26
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,448
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $598
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG843
Policy instance 4
Insurance contract or identification numberBG843
Number of Individuals Covered24
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,379
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,479
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 6
Insurance contract or identification number658833
Number of Individuals Covered52
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $5,635
Welfare Benefit Premiums Paid to CarrierUSD $215,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,635
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 5
Insurance contract or identification number121894
Number of Individuals Covered296
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $30,765
Welfare Benefit Premiums Paid to CarrierUSD $1,148,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,765
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 5
Insurance contract or identification number121894
Number of Individuals Covered267
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $24,244
Welfare Benefit Premiums Paid to CarrierUSD $976,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,244
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered91
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,170
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,186
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG841
Policy instance 2
Insurance contract or identification numberBG841
Number of Individuals Covered9
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $732
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $403
Insurance broker organization code?3
Insurance broker nameALAN M ANTONIO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG842
Policy instance 3
Insurance contract or identification numberBG842
Number of Individuals Covered30
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,326
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $670
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG843
Policy instance 4
Insurance contract or identification numberBG843
Number of Individuals Covered24
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,657
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,603
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number658833
Policy instance 2
Insurance contract or identification number658833
Number of Individuals Covered40
Insurance policy start date2012-01-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $1,753
Welfare Benefit Premiums Paid to CarrierUSD $69,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,753
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered102
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $19,276
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,320
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG841
Policy instance 3
Insurance contract or identification numberBG841
Number of Individuals Covered9
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,505
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $432
Insurance broker organization code?3
Insurance broker nameALAN M ANTONIO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG842
Policy instance 4
Insurance contract or identification numberBG842
Number of Individuals Covered33
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,945
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,057
Insurance broker organization code?3
Insurance broker nameSHANNON M PAGANO
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG843
Policy instance 5
Insurance contract or identification numberBG843
Number of Individuals Covered26
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,242
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,175
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
Insurance broker nameSHANNON M PAGANO
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 6
Insurance contract or identification number121894
Number of Individuals Covered279
Insurance policy start date2012-01-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $9,407
Welfare Benefit Premiums Paid to CarrierUSD $379,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,407
Insurance broker organization code?3
Insurance broker nameMARVIN MANDELBAUM
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered118
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $17,349
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 2
Insurance contract or identification number121894
Number of Individuals Covered282
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $18,740
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $837,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG841
Policy instance 3
Insurance contract or identification numberBG841
Number of Individuals Covered15
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,520
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG842
Policy instance 4
Insurance contract or identification numberBG842
Number of Individuals Covered37
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,237
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG843
Policy instance 5
Insurance contract or identification numberBG843
Number of Individuals Covered29
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,794
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number121894
Policy instance 2
Insurance contract or identification number121894
Number of Individuals Covered281
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $51,435
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $840,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberBG840
Policy instance 1
Insurance contract or identification numberBG840
Number of Individuals Covered69
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $22,745
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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