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VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 401k Plan overview

Plan NameVOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST
Plan identification number 501

VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST Benefits

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

401k Sponsoring company profile

VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES has sponsored the creation of one or more 401k plans.

Company Name:VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES
Employer identification number (EIN):371611873
NAIC Classification:525920
NAIC Description:Trusts, Estates, and Agency Accounts

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2018-07-27
5012016-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2017-06-21
5012015-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2016-05-20
5012014-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2015-08-25
5012013-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2014-06-24
5012012-01-01ANTHONY PIACENTINO ANTHONY PIACENTINO2013-08-19
5012011-01-01DAVE A. MILLER DAVE A. MILLER2012-07-13

Plan Statistics for VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST

401k plan membership statisitcs for VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST

Measure Date Value
2022: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01272
Total number of active participants reported on line 7a of the Form 55002022-01-01253
Total of all active and inactive participants2022-01-01253
2021: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01289
Total number of active participants reported on line 7a of the Form 55002021-01-01272
Total of all active and inactive participants2021-01-01272
2020: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-01348
Total number of active participants reported on line 7a of the Form 55002020-01-01289
Total of all active and inactive participants2020-01-01289
2019: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-01332
Total number of active participants reported on line 7a of the Form 55002019-01-01348
Total of all active and inactive participants2019-01-01348
2018: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-01317
Total number of active participants reported on line 7a of the Form 55002018-01-01332
Total of all active and inactive participants2018-01-01332
2017: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-01173
Total number of active participants reported on line 7a of the Form 55002017-01-01317
Total of all active and inactive participants2017-01-01317
2016: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-01208
Total number of active participants reported on line 7a of the Form 55002016-01-01173
Total of all active and inactive participants2016-01-01173
2015: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-01185
Total number of active participants reported on line 7a of the Form 55002015-01-01208
Total of all active and inactive participants2015-01-01208
2014: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01821
Total number of active participants reported on line 7a of the Form 55002014-01-01185
Total of all active and inactive participants2014-01-01185
2013: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01870
Total number of active participants reported on line 7a of the Form 55002013-01-01821
Total of all active and inactive participants2013-01-01821
2012: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01726
Total number of active participants reported on line 7a of the Form 55002012-01-01870
Total of all active and inactive participants2012-01-01870
2011: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-010
Total number of active participants reported on line 7a of the Form 55002011-01-01726
Total of all active and inactive participants2011-01-01726

Form 5500 Responses for VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST

2022: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: VOLUNTARY BENEFIT TRUST FOR AIRLINE RETIREES F/K/A DP3 VEBA TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-030188
Policy instance 2
Insurance contract or identification numberAGP-030188
Number of Individuals Covered17
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,211
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $24,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,211
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 1
Insurance contract or identification number421179
Number of Individuals Covered253
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $54,881
Total amount of fees paid to insurance companyUSD $2,605
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,881
Insurance broker organization code?3
Amount paid for insurance broker fees2605
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-020088
Policy instance 6
Insurance contract or identification numberAGP-020088
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $399
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $189
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-024088
Policy instance 5
Insurance contract or identification numberAGP-024088
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,606
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $723
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-025088
Policy instance 4
Insurance contract or identification numberAGP-025088
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $422
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $163
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-030189
Policy instance 3
Insurance contract or identification numberAGP-030189
Number of Individuals Covered112
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,475
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $249,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,475
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 1
Insurance contract or identification number421179
Number of Individuals Covered272
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $70,404
Total amount of fees paid to insurance companyUSD $160
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,404
Amount paid for insurance broker fees160
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-030188
Policy instance 2
Insurance contract or identification numberAGP-030188
Number of Individuals Covered17
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,912
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $38,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,912
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-030189
Policy instance 3
Insurance contract or identification numberAGP-030189
Number of Individuals Covered112
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $13,717
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $274,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,717
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-25088
Policy instance 4
Insurance contract or identification numberAGP-25088
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,166
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $450
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-024088
Policy instance 5
Insurance contract or identification numberAGP-024088
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,391
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $13,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,076
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP-020088
Policy instance 6
Insurance contract or identification numberAGP-020088
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $396
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedMEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 2
Insurance contract or identification number421179
Number of Individuals Covered289
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $94,477
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,477
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467351
Policy instance 1
Insurance contract or identification numberAE467351
Number of Individuals Covered22
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,125
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $157,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,125
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467352
Policy instance 4
Insurance contract or identification numberAE467352
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $8,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number39375
Policy instance 3
Insurance contract or identification number39375
Number of Individuals Covered9
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 2
Insurance contract or identification number421179
Number of Individuals Covered348
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $144,857
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $144,857
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467351
Policy instance 1
Insurance contract or identification numberAE467351
Number of Individuals Covered33
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,250
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $52,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,250
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 2
Insurance contract or identification number421179
Number of Individuals Covered332
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $122,897
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $122,897
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444686
Policy instance 1
Insurance contract or identification numberAE444686
Number of Individuals Covered9
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $22,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $225
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444685
Policy instance 2
Insurance contract or identification numberAE444685
Number of Individuals Covered49
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,525
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $52,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,525
Insurance broker organization code?3
Insurance broker nameCONE RETIREE HEALTHCARE GROUP, LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444684
Policy instance 3
Insurance contract or identification numberAE444684
Number of Individuals Covered3
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $9,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $225
Insurance broker organization code?3
Insurance broker nameCONE RETIREE HEALTHCARE GROUP, LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444688
Policy instance 4
Insurance contract or identification numberAE444688
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $75
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $3,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
Insurance broker nameCONE RETIREE HEALTHCARE GROUP, LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE456860
Policy instance 5
Insurance contract or identification numberAE456860
Number of Individuals Covered20
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $11,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444689
Policy instance 6
Insurance contract or identification numberAE444689
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $150
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150
Insurance broker organization code?3
Insurance broker nameCONE RETIREE HEALTHCARE GROUP, LLC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number421179
Policy instance 7
Insurance contract or identification number421179
Number of Individuals Covered317
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $121,675
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $121,675
Insurance broker organization code?3
Insurance broker nameCATHY J. CONE
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE444686
Policy instance 1
Insurance contract or identification numberAE444686
Number of Individuals Covered13
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $275
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $26,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $275
Insurance broker organization code?3
Insurance broker nameCONE RETIREE HEALTHCARE GROUP, LLC

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