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GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 401k Plan overview

Plan NameGROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY
Plan identification number 502

GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY Benefits

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

401k Sponsoring company profile

DEPAUW UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name:DEPAUW UNIVERSITY
Employer identification number (EIN):350869045
NAIC Classification:611000

Additional information about DEPAUW UNIVERSITY

Jurisdiction of Incorporation: Oklahoma Secretary Of State
Incorporation Date:
Company Identification Number: 4312034461

More information about DEPAUW UNIVERSITY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01ANDREA YOUNG2023-07-17
5022021-07-01BOB LEONARD2022-06-27
5022020-07-01BOB LEONARD2022-04-15
5022019-07-01
5022018-07-01
5022017-07-01ROBERT LEONARD ROBERT LEONARD2019-01-29
5022016-07-01ROBERT LEONARD ROBERT LEONARD2018-04-06
5022015-07-01BRAD KELSHEIMER BRAD KELSHEIMER2017-01-30
5022014-07-01BRAD KELSHEIMER BRAD KELSHEIMER2016-01-21
5022013-07-01BRAD KELSHEIMER BRAD KELSHEIMER2015-01-30
5022012-07-01BRAD KELSHEIMER BRAD KELSHEIMER2014-01-30
5022011-07-01BRAD KELSHEIMER BRAD KELSHEIMER2013-01-23
5022009-07-01BRAD KELSHEIMER BRAD KELSHEIMER2011-01-27

Plan Statistics for GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY

401k plan membership statisitcs for GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY

Measure Date Value
2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2022 401k membership
Total participants, beginning-of-year2022-01-01821
Total number of active participants reported on line 7a of the Form 55002022-01-01562
Number of retired or separated participants receiving benefits2022-01-01249
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01811
Number of employers contributing to the scheme2022-01-010
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2021 401k membership
Total participants, beginning-of-year2021-07-01819
Total number of active participants reported on line 7a of the Form 55002021-07-01535
Number of retired or separated participants receiving benefits2021-07-01290
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01825
Number of employers contributing to the scheme2021-07-010
2020: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2020 401k membership
Total participants, beginning-of-year2020-07-01841
Total number of active participants reported on line 7a of the Form 55002020-07-01552
Number of retired or separated participants receiving benefits2020-07-01297
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01849
Number of employers contributing to the scheme2020-07-010
2019: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2019 401k membership
Total participants, beginning-of-year2019-07-01888
Total number of active participants reported on line 7a of the Form 55002019-07-01862
Number of retired or separated participants receiving benefits2019-07-011
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01863
2018: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2018 401k membership
Total participants, beginning-of-year2018-07-01896
Total number of active participants reported on line 7a of the Form 55002018-07-01887
Number of retired or separated participants receiving benefits2018-07-011
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01888
2017: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2017 401k membership
Total participants, beginning-of-year2017-07-01872
Total number of active participants reported on line 7a of the Form 55002017-07-01895
Number of retired or separated participants receiving benefits2017-07-011
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01896
2016: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2016 401k membership
Total participants, beginning-of-year2016-07-01886
Total number of active participants reported on line 7a of the Form 55002016-07-01868
Number of retired or separated participants receiving benefits2016-07-014
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01872
2015: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2015 401k membership
Total participants, beginning-of-year2015-07-01871
Total number of active participants reported on line 7a of the Form 55002015-07-01885
Number of retired or separated participants receiving benefits2015-07-011
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01886
2014: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2014 401k membership
Total participants, beginning-of-year2014-07-01874
Total number of active participants reported on line 7a of the Form 55002014-07-01870
Number of retired or separated participants receiving benefits2014-07-013
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01873
2013: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2013 401k membership
Total participants, beginning-of-year2013-07-01753
Total number of active participants reported on line 7a of the Form 55002013-07-01598
Number of retired or separated participants receiving benefits2013-07-011
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01599
2012: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2012 401k membership
Total participants, beginning-of-year2012-07-01577
Total number of active participants reported on line 7a of the Form 55002012-07-01610
Number of retired or separated participants receiving benefits2012-07-014
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01614
2011: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2011 401k membership
Total participants, beginning-of-year2011-07-01561
Total number of active participants reported on line 7a of the Form 55002011-07-01583
Number of retired or separated participants receiving benefits2011-07-012
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01585
2009: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2009 401k membership
Total participants, beginning-of-year2009-07-01873
Total number of active participants reported on line 7a of the Form 55002009-07-01588
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01588
Total participants2009-07-010

Form 5500 Responses for GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY

2022: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01This return/report is a short plan year return/report (less than 12 months)Yes
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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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: GROUP INSURANCE PLAN FOR EMPLOYEES OF DEPAUW UNIVERSITY 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

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW10193
Policy instance 3
Insurance contract or identification numberW10193
Number of Individuals Covered1160
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number210
Policy instance 2
Insurance contract or identification number210
Number of Individuals Covered1112
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered829
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $46,896
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $344,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,596
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered862
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $51,374
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $350,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,374
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number210
Policy instance 2
Insurance contract or identification number210
Number of Individuals Covered1108
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $407
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees407
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW10193
Policy instance 3
Insurance contract or identification numberW10193
Number of Individuals Covered1135
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered862
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $50,169
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $370,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $50,169
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW10193
Policy instance 2
Insurance contract or identification numberW10193
Number of Individuals Covered1135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number210
Policy instance 3
Insurance contract or identification number210
Number of Individuals Covered1479
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,069
Total amount of fees paid to insurance companyUSD $2,531
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,069
Amount paid for insurance broker fees2531
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW10193
Policy instance 3
Insurance contract or identification numberW10193
Number of Individuals Covered1144
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number0000210
Policy instance 2
Insurance contract or identification number0000210
Number of Individuals Covered1214
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,136
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2136
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS, RETENTION BONUS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered862
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $45,991
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $379,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,991
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered887
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $56,802
Total amount of fees paid to insurance companyUSD $9,129
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $391,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,802
Insurance broker organization code?3
Amount paid for insurance broker fees9129
Additional information about fees paid to insurance brokerBONUS AMOUNT
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number0000210
Policy instance 2
Insurance contract or identification number0000210
Number of Individuals Covered1286
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,157
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1157
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS, RETENTION BONUS
Insurance broker organization code?3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberW10193
Policy instance 3
Insurance contract or identification numberW10193
Number of Individuals Covered1182
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number0000210
Policy instance 2
Insurance contract or identification number0000210
Number of Individuals Covered1390
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00228614
Policy instance 3
Insurance contract or identification number00228614
Number of Individuals Covered1305
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,258
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered895
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $55,894
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $356,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered885
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $22,594
Total amount of fees paid to insurance companyUSD $659
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $217,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,594
Insurance broker organization code?3
Amount paid for insurance broker fees659
Additional information about fees paid to insurance brokerBONUS AMOUNT PAID
Insurance broker nameUNITED BENEFITS ADVISORS INC.
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number0000210
Policy instance 2
Insurance contract or identification number0000210
Number of Individuals Covered1386
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00228614
Policy instance 3
Insurance contract or identification number00228614
Number of Individuals Covered803
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 $393
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees393
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameLOCASCIO HADDEN & DENNIS LLC
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00228614
Policy instance 4
Insurance contract or identification number00228614
Number of Individuals Covered1190
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )
Policy contract number0000210
Policy instance 3
Insurance contract or identification number0000210
Number of Individuals Covered1368
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 2
Insurance contract or identification number202003
Number of Individuals Covered651
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $11,483
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,284
Insurance broker organization code?3
Insurance broker nameUNITED BENEFITS ADVISORS INC.
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number202003
Policy instance 1
Insurance contract or identification number202003
Number of Individuals Covered870
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $38,640
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $253,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,081
Insurance broker organization code?3
Insurance broker nameUNITED BENEFITS ADVISORS INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00228614
Policy instance 1
Insurance contract or identification number00228614
Number of Individuals Covered1189
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number2471922
Policy instance 1
Insurance contract or identification number2471922
Number of Individuals Covered510
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number2471922
Policy instance 1
Insurance contract or identification number2471922
Number of Individuals Covered1340
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number2471922
Policy instance 1
Insurance contract or identification number2471922
Number of Individuals Covered1327
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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