WOODWARD, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WOODWARD EMPLOYEE WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2014 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $6,336,548 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $6,260,588 |
| Total income from all sources (including contributions) | 2014-12-31 | $77,443,320 |
| Total of all expenses incurred | 2014-12-31 | $78,809,653 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $74,833,258 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $77,443,320 |
| Value of total assets at end of year | 2014-12-31 | $1,912,548 |
| Value of total assets at beginning of year | 2014-12-31 | $3,202,921 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $3,976,395 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $447,853 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $20,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $13,193,060 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $171,466 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $289,721 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $472,729 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $631,075 |
| Total non interest bearing cash at end of year | 2014-12-31 | $701,598 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $702,577 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-1,366,333 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $-4,424,000 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $-3,057,667 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $8,040,564 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $64,250,260 |
| Employer contributions (assets) at end of year | 2014-12-31 | $1,039,484 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $2,210,623 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $66,792,694 |
| Contract administrator fees | 2014-12-31 | $3,528,542 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $5,863,819 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $5,629,513 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | BENNING GROUP, LLC |
| Accountancy firm EIN | 2014-12-31 | 300003878 |
| 2013 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $6,260,588 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $7,018,833 |
| Total income from all sources (including contributions) | 2013-12-31 | $74,387,969 |
| Total of all expenses incurred | 2013-12-31 | $74,822,592 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $70,730,744 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $74,387,969 |
| Value of total assets at end of year | 2013-12-31 | $3,202,921 |
| Value of total assets at beginning of year | 2013-12-31 | $4,395,789 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $4,091,848 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $811,174 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $9,679,023 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $289,721 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $86,734 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $631,075 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $458,304 |
| Total non interest bearing cash at end of year | 2013-12-31 | $702,577 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $725,158 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-434,623 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $-3,057,667 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $-2,623,044 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $5,851 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $5,991,764 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $64,708,946 |
| Employer contributions (assets) at end of year | 2013-12-31 | $2,210,623 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $3,583,897 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $64,738,980 |
| Contract administrator fees | 2013-12-31 | $3,274,823 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $5,629,513 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $6,560,529 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | BENNING GROUP, LLC |
| Accountancy firm EIN | 2013-12-31 | 300003878 |
| 2012 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $7,018,833 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $6,214,843 |
| Total income from all sources (including contributions) | 2012-12-31 | $69,620,745 |
| Total of all expenses incurred | 2012-12-31 | $70,062,445 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $66,374,586 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $69,620,745 |
| Value of total assets at end of year | 2012-12-31 | $4,395,789 |
| Value of total assets at beginning of year | 2012-12-31 | $4,033,499 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $3,687,859 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $411,512 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $9,117,938 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $86,734 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $3,527 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $458,304 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $386,101 |
| Total non interest bearing cash at end of year | 2012-12-31 | $725,158 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $805,848 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-441,700 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $-2,623,044 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $-2,181,344 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $4,545 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $4,162,930 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $60,502,807 |
| Employer contributions (assets) at end of year | 2012-12-31 | $3,583,897 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $3,224,124 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $62,211,656 |
| Contract administrator fees | 2012-12-31 | $3,271,802 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $6,560,529 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $5,828,742 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | BENNING GROUP, LLC |
| Accountancy firm EIN | 2012-12-31 | 300003878 |
| 2011 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $6,214,843 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $5,923,738 |
| Total income from all sources (including contributions) | 2011-12-31 | $58,945,811 |
| Total of all expenses incurred | 2011-12-31 | $58,642,151 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $55,500,911 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $58,945,811 |
| Value of total assets at end of year | 2011-12-31 | $4,033,499 |
| Value of total assets at beginning of year | 2011-12-31 | $3,438,734 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $3,141,240 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $467,206 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $8,657,431 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $3,527 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $373,521 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $386,101 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $389,759 |
| Total non interest bearing cash at end of year | 2011-12-31 | $805,848 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $546,048 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $303,660 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $-2,181,344 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $-2,485,004 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $4,343 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $3,592,179 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $50,288,380 |
| Employer contributions (assets) at end of year | 2011-12-31 | $3,224,124 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $2,519,165 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $51,908,732 |
| Contract administrator fees | 2011-12-31 | $2,669,691 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $5,828,742 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $5,533,979 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | SIKICH LLP |
| Accountancy firm EIN | 2011-12-31 | 363168081 |
| 2010 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $5,923,738 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $4,322,075 |
| Total income from all sources (including contributions) | 2010-12-31 | $54,049,700 |
| Total of all expenses incurred | 2010-12-31 | $56,380,195 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $53,711,682 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $54,049,700 |
| Value of total assets at end of year | 2010-12-31 | $3,438,734 |
| Value of total assets at beginning of year | 2010-12-31 | $4,167,566 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $2,668,513 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $246,320 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $8,649,414 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $389,759 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $286,147 |
| Total non interest bearing cash at end of year | 2010-12-31 | $546,048 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $1,897,254 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-2,330,495 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $-2,485,004 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $-154,509 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $6,250 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $3,705,755 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $45,400,286 |
| Employer contributions (assets) at end of year | 2010-12-31 | $2,892,686 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $2,270,312 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $50,005,927 |
| Contract administrator fees | 2010-12-31 | $2,415,943 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $5,533,979 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $4,035,928 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | SIKICH LLP |
| Accountancy firm EIN | 2010-12-31 | 363168081 |
| 2008 : WOODWARD EMPLOYEE WELFARE BENEFIT PLAN 2008 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2008-12-31 | $4,310,120 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2008-12-31 | $3,448,906 |
| Total income from all sources (including contributions) | 2008-12-31 | $42,000,620 |
| Total of all expenses incurred | 2008-12-31 | $42,386,820 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2008-12-31 | $39,612,904 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2008-12-31 | $41,986,941 |
| Value of total assets at end of year | 2008-12-31 | $2,784,753 |
| Value of total assets at beginning of year | 2008-12-31 | $2,309,739 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2008-12-31 | $2,773,916 |
| Total interest from all sources | 2008-12-31 | $13,679 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2008-12-31 | No |
| Administrative expenses professional fees incurred | 2008-12-31 | $273,069 |
| Was this plan covered by a fidelity bond | 2008-12-31 | Yes |
| Value of fidelity bond cover | 2008-12-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2008-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2008-12-31 | No |
| Contributions received from participants | 2008-12-31 | $6,637,304 |
| Assets. Other investments not covered elsewhere at end of year | 2008-12-31 | $193,906 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2008-12-31 | $212,424 |
| Administrative expenses (other) incurred | 2008-12-31 | $2,483,114 |
| Liabilities. Value of operating payables at beginning of year | 2008-12-31 | $241,678 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2008-12-31 | No |
| Value of net income/loss | 2008-12-31 | $-386,200 |
| Value of net assets at end of year (total assets less liabilities) | 2008-12-31 | $-1,525,367 |
| Value of net assets at beginning of year (total assets less liabilities) | 2008-12-31 | $-1,139,167 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2008-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2008-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2008-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2008-12-31 | $-634,994 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2008-12-31 | $-406,409 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2008-12-31 | $-406,409 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2008-12-31 | $13,679 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2008-12-31 | $255,741 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2008-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2008-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2008-12-31 | No |
| Contributions received in cash from employer | 2008-12-31 | $35,349,637 |
| Employer contributions (assets) at end of year | 2008-12-31 | $3,225,841 |
| Employer contributions (assets) at beginning of year | 2008-12-31 | $2,716,148 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2008-12-31 | $39,357,163 |
| Contract administrator fees | 2008-12-31 | $17,733 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2008-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2008-12-31 | $4,097,696 |
| Liabilities. Value of benefit claims payable at beginning of year | 2008-12-31 | $3,207,228 |
| Did the plan have assets held for investment | 2008-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2008-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2008-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2008-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2008-12-31 | Unqualified |
| Accountancy firm name | 2008-12-31 | SIKICH LLP |
| Accountancy firm EIN | 2008-12-31 | 363168081 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332331 |
| Policy instance | 2 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $309 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,354 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 309 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| EMPATHIA, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | |
| Policy instance | 11 |
| Number of Individuals Covered | 5946 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $162,854 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 833 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $452,796 | | 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 number | 101580 |
| Policy instance | 3 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,428,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 4 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7921 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $61,014 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,211 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 5 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 5229 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $100,226 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $88,253 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 6 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 5334 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $775,790 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 3332331 |
| Policy instance | 7 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | AWF50278001 |
| Policy instance | 8 |
| Insurance contract or identification number | AWF50278001 | | Number of Individuals Covered | 531 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $119,160 | | Welfare Benefit Premiums Paid to Carrier | USD $1,174,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,827 | | Insurance broker organization code? | 5 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 174208 |
| Policy instance | 9 |
| Insurance contract or identification number | 174208 | | Number of Individuals Covered | 5090 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0912838H0000A |
| Policy instance | 10 |
| Insurance contract or identification number | MZ0912838H0000A | | Number of Individuals Covered | 531 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $834,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 895 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $482,959 | | 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 number | 101580 |
| Policy instance | 3 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 744 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,311,326 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 4 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7025 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $56,047 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,225 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 6 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4858 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $803,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 5 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4464 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $79,529 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,631 | | Insurance broker organization code? | 3 |
|
| CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 3332331 |
| Policy instance | 7 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | AWF50278001 |
| Policy instance | 8 |
| Insurance contract or identification number | AWF50278001 | | Number of Individuals Covered | 580 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $127,098 | | Welfare Benefit Premiums Paid to Carrier | USD $1,226,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,612 | | Insurance broker organization code? | 5 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332331 |
| Policy instance | 2 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $403 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,945 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 403 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0912838H0000A |
| Policy instance | 10 |
| Insurance contract or identification number | MZ0912838H0000A | | Number of Individuals Covered | 578 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $891,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 174208 |
| Policy instance | 9 |
| Insurance contract or identification number | 174208 | | Number of Individuals Covered | 4505 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $2,992,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 3332331 |
| Policy instance | 7 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | AWF50278001 |
| Policy instance | 8 |
| Insurance contract or identification number | AWF50278001 | | Number of Individuals Covered | 612 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $136,261 | | Welfare Benefit Premiums Paid to Carrier | USD $1,314,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,135 | | Insurance broker organization code? | 5 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 4 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7209 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $57,160 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,752 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 101580 |
| Policy instance | 3 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 807 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,268,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 174208 |
| Policy instance | 9 |
| Insurance contract or identification number | 174208 | | Number of Individuals Covered | 4471 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $2,862,975 | | 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 number | 3332331 |
| Policy instance | 2 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $441 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 441 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 941 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $514,732 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 6 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4823 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $794,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 5 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4567 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $90,515 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,815 | | Insurance broker organization code? | 3 |
|
| MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MZ0912838H0000A |
| Policy instance | 10 |
| Insurance contract or identification number | MZ0912838H0000A | | Number of Individuals Covered | 612 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $953,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | EXRK 70962-0 |
| Policy instance | 10 |
| Insurance contract or identification number | EXRK 70962-0 | | Number of Individuals Covered | 5103 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $2,508,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 5 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 5127 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $85,095 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,640 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332331 |
| Policy instance | 2 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $497 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 497 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 4 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7900 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $54,755 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,553 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 101580 |
| Policy instance | 3 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 789 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,541,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 7 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 5505 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $934,318 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 1023 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $52,627 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $526,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,627 | | Insurance broker organization code? | 3 |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 8 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,015,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ENVISION INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77399 ) |
| Policy contract number | AWF50278001 |
| Policy instance | 9 |
| Insurance contract or identification number | AWF50278001 | | Number of Individuals Covered | 667 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $156,733 | | Welfare Benefit Premiums Paid to Carrier | USD $1,393,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $98,968 | | Insurance broker organization code? | 5 |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 6 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 667 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $132,809 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,026,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $132,809 | | Insurance broker organization code? | 3 |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 9 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,900,671 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579018 |
| Policy instance | 4 |
| Insurance contract or identification number | S9579018 | | Number of Individuals Covered | 696 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,857,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 5 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 5522 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $46,442 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,075 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 5057 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $86,562 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,211 | | Insurance broker organization code? | 3 |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 7 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 696 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $139,947 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,072,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $139,947 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 8 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 5346 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $894,293 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 1474 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $50,523 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $505,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,523 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL33860 |
| Policy instance | 10 |
| Insurance contract or identification number | HCL33860 | | Number of Individuals Covered | 4885 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $2,076,151 | | 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 number | 101580 |
| Policy instance | 3 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 746 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,838,224 | | 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 number | 3332331 |
| Policy instance | 2 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7338 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $57,453 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,625 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING INC |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | EXRK 69350-2 |
| Policy instance | 12 |
| Insurance contract or identification number | EXRK 69350-2 | | Number of Individuals Covered | 4641 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,980,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) |
| Policy contract number | 20281 |
| Policy instance | 11 |
| Insurance contract or identification number | 20281 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $291,317 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 10 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,978,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 9 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4658 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $804,436 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 8 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 741 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $148,722 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,132,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $148,722 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 1540 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $57,434 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $574,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,040 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 174208 |
| Policy instance | 2 |
| Insurance contract or identification number | 174208 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,441,817 | | 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 number | 3332331 |
| Policy instance | 3 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $238,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 7 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4698 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $75,272 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,835 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP NATIONAL ACCOUNT SERVICES |
|
| STONEBRIDGE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579 |
| Policy instance | 5 |
| Insurance contract or identification number | S9579 | | Number of Individuals Covered | 741 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $63,592 | | Welfare Benefit Premiums Paid to Carrier | USD $1,910,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,592 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 101580 |
| Policy instance | 4 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 731 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,800,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 9 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4552 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $665,845 | | 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 number | 225240 |
| Policy instance | 12 |
| Insurance contract or identification number | 225240 | | Number of Individuals Covered | 4524 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $9,725 | | Welfare Benefit Premiums Paid to Carrier | USD $1,653,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9725 | | Additional information about fees paid to insurance broker | 2014 BONUS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | NFP INSURANCE SERVICES INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 101580 |
| Policy instance | 4 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 746 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,830,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) |
| Policy contract number | 20281 |
| Policy instance | 11 |
| Insurance contract or identification number | 20281 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $283,519 | | 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 number | 3332331 |
| Policy instance | 3 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $252,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 025859 |
| Policy instance | 2 |
| Insurance contract or identification number | 025859 | | Number of Individuals Covered | 11537 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,000 | | Insurance broker organization code? | 3 | | Insurance broker name | J R KATZ INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 759 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $59,077 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $590,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,992 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 10 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 291 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,696,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7201 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $50,528 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,865 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 8 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 796 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $144,945 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,106,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,833 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 7 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4681 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $49,941 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,519 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP NATIONAL ACCOUNT SERVICES |
|
| STONEBRIDGE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579 |
| Policy instance | 5 |
| Insurance contract or identification number | S9579 | | Number of Individuals Covered | 796 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $68,132 | | Welfare Benefit Premiums Paid to Carrier | USD $1,046,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,490 | | Insurance broker organization code? | 3 | | Insurance broker name | HEWITT ASSOCIATES LLC |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P25859 & P25860 |
| Policy instance | 2 |
| Insurance contract or identification number | P25859 & P25860 | | Number of Individuals Covered | 11417 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,000 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 795 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $57,123 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $571,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,123 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 10 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,173,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 7 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4524 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $63,032 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,868 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP NATIONAL ACCOUNT SERVICES |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 225240 |
| Policy instance | 12 |
| Insurance contract or identification number | 225240 | | Number of Individuals Covered | 4551 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,404,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) |
| Policy contract number | 20281 |
| Policy instance | 11 |
| Insurance contract or identification number | 20281 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $270,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 9 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4775 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $762,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 8 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 876 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $155,922 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,195,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $155,922 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3332331 |
| Policy instance | 3 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 302 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $243,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STONEBRIDGE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579 |
| Policy instance | 5 |
| Insurance contract or identification number | S9579 | | Number of Individuals Covered | 819 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $34,010 | | Welfare Benefit Premiums Paid to Carrier | USD $739,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,010 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7079 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $100,764 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,201 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 101580 |
| Policy instance | 4 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 729 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,625,907 | | 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 number | 3332331 |
| Policy instance | 3 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $228,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STONEBRIDGE (National Association of Insurance Commissioners NAIC id number: 65021 ) |
| Policy contract number | S9579 |
| Policy instance | 5 |
| Insurance contract or identification number | S9579 | | Number of Individuals Covered | 844 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $42,469 | | Welfare Benefit Premiums Paid to Carrier | USD $1,317,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,469 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P25859 & P25860 |
| Policy instance | 2 |
| Insurance contract or identification number | P25859 & P25860 | | Number of Individuals Covered | 11611 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $30,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,000 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 823 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $59,034 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $590,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,034 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 7008 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $81,798 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,479 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) |
| Policy contract number | 645579 |
| Policy instance | 8 |
| Insurance contract or identification number | 645579 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 10 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4394 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $728,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 9 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 833 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $162,599 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,238,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $162,599 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 ) |
| Policy contract number | 20281 |
| Policy instance | 12 |
| Insurance contract or identification number | 20281 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $181,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 7 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4390 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $61,137 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,430 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | W0002438 |
| Policy instance | 11 |
| Insurance contract or identification number | W0002438 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,426,426 | | 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 number | 225240 |
| Policy instance | 13 |
| Insurance contract or identification number | 225240 | | Number of Individuals Covered | 4343 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,033,754 | | 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 number | 101580 |
| Policy instance | 4 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 689 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,521,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P25859 & P25860 |
| Policy instance | 2 |
| Insurance contract or identification number | P25859 & P25860 | | Number of Individuals Covered | 11483 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $42,010 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $860,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,010 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 10 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4436 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $724,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ091283H0000A |
| Policy instance | 9 |
| Insurance contract or identification number | MZ091283H0000A | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $171,057 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,312,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $171,057 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) |
| Policy contract number | 645579 |
| Policy instance | 8 |
| Insurance contract or identification number | 645579 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Other welfare benefits provided | STATE DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 6 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 6902 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $80,613 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,295 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 801 |
| Policy instance | 5 |
| Insurance contract or identification number | 801 | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $2,637,340 | | 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 number | 3332331 |
| Policy instance | 3 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 303 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $226,436 | | 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 number | 101580 |
| Policy instance | 4 |
| Insurance contract or identification number | 101580 | | Number of Individuals Covered | 688 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,060,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 1 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 858 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $59,271 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $592,714 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,271 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 7 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4432 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $61,828 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,393 | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFIT PLANNING SERVICES, INC. |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 1 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 6598 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $78,598 | | 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 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 2 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 4192 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $55,537 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) |
| Policy contract number | 645579 |
| Policy instance | 3 |
| Insurance contract or identification number | 645579 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 4 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 910 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $62,384 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $623,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ0912838H0000A |
| Policy instance | 5 |
| Insurance contract or identification number | MZ0912838H0000A | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $187,584 | | 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 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,440,528 | | 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 number | 3332331 |
| Policy instance | 8 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $219,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 801 |
| Policy instance | 6 |
| Insurance contract or identification number | 801 | | Number of Individuals Covered | 1011 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $765,526 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P25859,P25860,O |
| Policy instance | 7 |
| Insurance contract or identification number | P25859,P25860,O | | Number of Individuals Covered | 11091 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $41,829 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $626,550 | | 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 number | 94-1340523 |
| Policy instance | 9 |
| Insurance contract or identification number | 94-1340523 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $2,729,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 12112474 |
| Policy instance | 10 |
| Insurance contract or identification number | 12112474 | | Number of Individuals Covered | 4236 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $681,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 1 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 6212 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $73,919 | | 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 | | Life Insurance Welfare Benefit | Yes | | 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 number | 94-1340523 |
| Policy instance | 9 |
| Insurance contract or identification number | 94-1340523 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $3,019,492 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 2 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 3722 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $56,386 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350603 |
| Policy instance | 4 |
| Insurance contract or identification number | 010350603 | | Number of Individuals Covered | 2094 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $69,525 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $580,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) |
| Policy contract number | 645579 |
| Policy instance | 3 |
| Insurance contract or identification number | 645579 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
| Policy contract number | MZ0912838H0000A |
| Policy instance | 5 |
| Insurance contract or identification number | MZ0912838H0000A | | Number of Individuals Covered | 994 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $192,296 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,488,801 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 801 |
| Policy instance | 6 |
| Insurance contract or identification number | 801 | | Number of Individuals Covered | 994 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,960,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | P25859,P25860,O |
| Policy instance | 7 |
| Insurance contract or identification number | P25859,P25860,O | | Number of Individuals Covered | 9735 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $58,923 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $466,722 | | 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 number | 3332331 |
| Policy instance | 8 |
| Insurance contract or identification number | 3332331 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,121 | | 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 number | 069171 |
| Policy instance | 3 |
| Insurance contract or identification number | 069171 | | Number of Individuals Covered | 2920 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $38,389 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $255,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 2 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 2881 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $33,531 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 641757 |
| Policy instance | 1 |
| Insurance contract or identification number | 641757 | | Number of Individuals Covered | 3668 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $40,148 | | 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 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
