INDIANA UNIVERSITY FOUNDATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN
401k plan membership statisitcs for INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN
| Measure | Date | Value |
|---|
| 2022: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 216 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 216 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 205 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 207 |
| 2020: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 222 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 215 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 217 |
| 2019: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 220 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 1 |
| Total of all active and inactive participants | 2019-01-01 | 221 |
| 2018: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 219 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 218 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 3 |
| Total of all active and inactive participants | 2018-01-01 | 221 |
| 2017: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 220 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 216 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 3 |
| Total of all active and inactive participants | 2017-01-01 | 219 |
| 2016: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 215 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 5 |
| Total of all active and inactive participants | 2016-01-01 | 220 |
| 2015: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 202 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 217 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 5 |
| Total of all active and inactive participants | 2015-01-01 | 222 |
| 2014: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 195 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 5 |
| Total of all active and inactive participants | 2014-07-01 | 200 |
| 2013: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 186 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 4 |
| Total of all active and inactive participants | 2013-07-01 | 190 |
| 2012: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 169 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 4 |
| Total of all active and inactive participants | 2012-07-01 | 173 |
| 2011: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 163 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 164 |
| 2009: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 186 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 2 |
| Total of all active and inactive participants | 2009-07-01 | 189 |
| Total participants, beginning-of-year | 2009-01-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 185 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 2 |
| Total of all active and inactive participants | 2009-01-01 | 188 |
| 2022: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: INDIANA UNIVERSITY FOUNDATION HEALTHCARE PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000639 |
| Policy instance | 1 |
| Insurance contract or identification number | 1000639 | | Number of Individuals Covered | 507 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $21,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE NORTH RIVER INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 21105 ) |
| Policy contract number | 417009412390 |
| Policy instance | 2 |
| Insurance contract or identification number | 417009412390 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $380,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417004412390 |
| Policy instance | 1 |
| Insurance contract or identification number | 417004412390 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $21,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417004412390 |
| Policy instance | 1 |
| Insurance contract or identification number | 417004412390 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $23,871 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE NORTH RIVER INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 21105 ) |
| Policy contract number | 417009412390 |
| Policy instance | 2 |
| Insurance contract or identification number | 417009412390 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $168,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417008412390 |
| Policy instance | 3 |
| Insurance contract or identification number | 417008412390 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $171,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | 417008412390 |
| Policy instance | 3 |
| Insurance contract or identification number | 417008412390 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $167,933 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | 417007412390 |
| Policy instance | 2 |
| Insurance contract or identification number | 417007412390 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $2,507 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $170,480 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,507 | | Additional information about fees paid to insurance broker | BROKER COMMISSIONS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417004412390 |
| Policy instance | 1 |
| Insurance contract or identification number | 417004412390 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $25,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | 417007412390 |
| Policy instance | 2 |
| Insurance contract or identification number | 417007412390 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $344,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417004412390 |
| Policy instance | 1 |
| Insurance contract or identification number | 417004412390 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,537 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $25,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,537 | | Additional information about fees paid to insurance broker | BROKER COMMISSION |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | 417007412390 |
| Policy instance | 3 |
| Insurance contract or identification number | 417007412390 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $169,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 417004412390 |
| Policy instance | 2 |
| Insurance contract or identification number | 417004412390 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,757 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $27,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,757 | | Insurance broker name | APEX BENEFITS GROUP INC |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | 417005412390 |
| Policy instance | 1 |
| Insurance contract or identification number | 417005412390 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $176,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-201920 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-201920 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $93,882 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $366,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 67049 | | Additional information about fees paid to insurance broker | FEES - TPA | | Insurance broker organization code? | 5 | | Insurance broker name | AMERICAN HEALTH DATA INSTITUTE |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 1000639 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000639 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,039 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $30,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,039 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker name | KEY BENEFIT ADMINISTRATORS, INC. |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-201920 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-201920 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,430 | | Total amount of fees paid to insurance company | USD $43,964 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $249,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,430 | | Amount paid for insurance broker fees | 31433 | | Additional information about fees paid to insurance broker | FEES-TPA | | Insurance broker organization code? | 5 | | Insurance broker name | AMERICAN HEALTH DATA INSTITUTE |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | G1050-2013R4 |
| Policy instance | 1 |
| Insurance contract or identification number | G1050-2013R4 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,860 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $295,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,860 | | Insurance broker name | MEDICAL EXCESS INS. UNDERWRITERS |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | G1050-2012R3 |
| Policy instance | 1 |
| Insurance contract or identification number | G1050-2012R3 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $3,206 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $250,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,206 | | Insurance broker name | MEDICAL EXCESS INS. UNDERWRITERS |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | G1062-2010 |
| Policy instance | 1 |
| Insurance contract or identification number | G1062-2010 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $2,784 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $235,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | G1062-2010 |
| Policy instance | 1 |
| Insurance contract or identification number | G1062-2010 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $2,458 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $192,893 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
