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CHARTERSHIELD SCHOOL BENEFITS TRUST 401k Plan overview

Plan NameCHARTERSHIELD SCHOOL BENEFITS TRUST
Plan identification number 501

CHARTERSHIELD SCHOOL BENEFITS TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • 10 or more employer plan under Code section 419A(f)(6).

401k Sponsoring company profile

BOARD OF TRUSTEES, CHARTERSHIELD SCHOOL BENEFITS TRUST has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES, CHARTERSHIELD SCHOOL BENEFITS TRUST
Employer identification number (EIN):387135098
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHARTERSHIELD SCHOOL BENEFITS TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-07-01
5012017-07-01
5012016-07-01MILLER KAPLAN ARASE LLP
5012015-07-01MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP2017-04-17
5012015-01-01MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP2016-04-08

Plan Statistics for CHARTERSHIELD SCHOOL BENEFITS TRUST

401k plan membership statisitcs for CHARTERSHIELD SCHOOL BENEFITS TRUST

Measure Date Value
2018: CHARTERSHIELD SCHOOL BENEFITS TRUST 2018 401k membership
Total participants, beginning-of-year2018-07-01988
Total of all active and inactive participants2018-07-010
Total participants2018-07-010
2017: CHARTERSHIELD SCHOOL BENEFITS TRUST 2017 401k membership
Total participants, beginning-of-year2017-07-01739
Total number of active participants reported on line 7a of the Form 55002017-07-01988
Number of retired or separated participants receiving benefits2017-07-014
Number of other retired or separated participants entitled to future benefits2017-07-014
Total of all active and inactive participants2017-07-01996
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-01996
Number of participants with account balances2017-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-010
2016: CHARTERSHIELD SCHOOL BENEFITS TRUST 2016 401k membership
Total participants, beginning-of-year2016-07-01413
Total number of active participants reported on line 7a of the Form 55002016-07-01540
Number of retired or separated participants receiving benefits2016-07-012
Number of other retired or separated participants entitled to future benefits2016-07-012
Total of all active and inactive participants2016-07-01544
Total participants2016-07-01544
2015: CHARTERSHIELD SCHOOL BENEFITS TRUST 2015 401k membership
Total participants, beginning-of-year2015-07-01113
Total number of active participants reported on line 7a of the Form 55002015-07-01413
Number of retired or separated participants receiving benefits2015-07-010
Total of all active and inactive participants2015-07-01413
Total participants2015-07-01413
Total participants, beginning-of-year2015-01-010
Total number of active participants reported on line 7a of the Form 55002015-01-0129
Number of retired or separated participants receiving benefits2015-01-010
Total of all active and inactive participants2015-01-0129
Total participants2015-01-0129

Financial Data on CHARTERSHIELD SCHOOL BENEFITS TRUST

Measure Date Value
2019 : CHARTERSHIELD SCHOOL BENEFITS TRUST 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$764,520
Total income from all sources (including contributions)2019-06-30$8,688,086
Total of all expenses incurred2019-06-30$8,695,600
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$8,104,280
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$8,680,871
Value of total assets at end of year2019-06-30$0
Value of total assets at beginning of year2019-06-30$772,034
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$591,320
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2019-06-30$0
Administrative expenses professional fees incurred2019-06-30$40,972
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$53,498
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-06-30$28,068
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-06-30$40,000
Other income not declared elsewhere2019-06-30$7,215
Administrative expenses (other) incurred2019-06-30$426,099
Liabilities. Value of operating payables at end of year2019-06-30$0
Liabilities. Value of operating payables at beginning of year2019-06-30$724,520
Total non interest bearing cash at end of year2019-06-30$0
Total non interest bearing cash at beginning of year2019-06-30$709,205
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$-7,514
Value of net assets at end of year (total assets less liabilities)2019-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$7,514
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$8,104,280
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$8,627,373
Employer contributions (assets) at end of year2019-06-30$0
Employer contributions (assets) at beginning of year2019-06-30$34,761
Contract administrator fees2019-06-30$124,249
Did the plan have assets held for investment2019-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Unqualified
Accountancy firm name2019-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2019-06-30952036255
2018 : CHARTERSHIELD SCHOOL BENEFITS TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$764,520
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$520,856
Total income from all sources (including contributions)2018-06-30$9,251,467
Total of all expenses incurred2018-06-30$9,213,739
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$8,590,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$9,251,467
Value of total assets at end of year2018-06-30$772,034
Value of total assets at beginning of year2018-06-30$490,642
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$622,813
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Administrative expenses professional fees incurred2018-06-30$29,477
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$27,490
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-06-30$28,068
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-06-30$40,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-06-30$40,000
Administrative expenses (other) incurred2018-06-30$460,088
Liabilities. Value of operating payables at end of year2018-06-30$724,520
Liabilities. Value of operating payables at beginning of year2018-06-30$480,856
Total non interest bearing cash at end of year2018-06-30$709,205
Total non interest bearing cash at beginning of year2018-06-30$376,506
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$37,728
Value of net assets at end of year (total assets less liabilities)2018-06-30$7,514
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$-30,214
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-06-30$8,590,926
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30No
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$9,223,977
Employer contributions (assets) at end of year2018-06-30$34,761
Employer contributions (assets) at beginning of year2018-06-30$114,136
Contract administrator fees2018-06-30$133,248
Did the plan have assets held for investment2018-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30No
Opinion of an independent qualified public accountant for this plan2018-06-30Unqualified
Accountancy firm name2018-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2018-06-30952036255
2017 : CHARTERSHIELD SCHOOL BENEFITS TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$520,856
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$397,846
Total income from all sources (including contributions)2017-06-30$5,019,033
Total of all expenses incurred2017-06-30$4,985,280
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$4,656,169
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$5,019,033
Value of total assets at end of year2017-06-30$490,642
Value of total assets at beginning of year2017-06-30$333,879
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$329,111
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Administrative expenses professional fees incurred2017-06-30$24,634
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$13,017
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$4,912
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-06-30$40,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-06-30$40,000
Administrative expenses (other) incurred2017-06-30$211,575
Liabilities. Value of operating payables at end of year2017-06-30$480,856
Liabilities. Value of operating payables at beginning of year2017-06-30$357,846
Total non interest bearing cash at end of year2017-06-30$376,506
Total non interest bearing cash at beginning of year2017-06-30$265,633
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$33,753
Value of net assets at end of year (total assets less liabilities)2017-06-30$-30,214
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$-63,967
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$4,656,169
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30No
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$5,006,016
Employer contributions (assets) at end of year2017-06-30$114,136
Employer contributions (assets) at beginning of year2017-06-30$63,334
Contract administrator fees2017-06-30$92,902
Did the plan have assets held for investment2017-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2017-06-30952036255
2016 : CHARTERSHIELD SCHOOL BENEFITS TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$397,846
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$67,683
Total income from all sources (including contributions)2016-06-30$2,703,522
Total of all expenses incurred2016-06-30$2,767,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$2,537,819
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$2,703,522
Value of total assets at end of year2016-06-30$333,879
Value of total assets at beginning of year2016-06-30$67,847
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$229,834
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Administrative expenses professional fees incurred2016-06-30$210,826
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$4,912
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-06-30$40,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-06-30$67,090
Administrative expenses (other) incurred2016-06-30$19,008
Liabilities. Value of operating payables at end of year2016-06-30$357,846
Liabilities. Value of operating payables at beginning of year2016-06-30$593
Total non interest bearing cash at end of year2016-06-30$265,633
Total non interest bearing cash at beginning of year2016-06-30$67,847
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$-64,131
Value of net assets at end of year (total assets less liabilities)2016-06-30$-63,967
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$164
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$2,537,819
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$2,703,522
Employer contributions (assets) at end of year2016-06-30$63,334
Employer contributions (assets) at beginning of year2016-06-30$0
Did the plan have assets held for investment2016-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2016-06-30952036255
2015 : CHARTERSHIELD SCHOOL BENEFITS TRUST 2015 401k financial data
Total plan liabilities at end of year2015-06-30$593
Total plan liabilities at beginning of year2015-06-30$0
Total income from all sources2015-06-30$3,426
Expenses. Total of all expenses incurred2015-06-30$3,261
Total plan assets at end of year2015-06-30$758
Total plan assets at beginning of year2015-06-30$0
Value of fidelity bond covering the plan2015-06-30$500,000
Expenses. Other expenses not covered elsewhere2015-06-30$3,261
Net income (gross income less expenses)2015-06-30$165
Net plan assets at end of year (total assets less liabilities)2015-06-30$165
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$0
Total contributions received or receivable from employer(s)2015-06-30$3,426

Form 5500 Responses for CHARTERSHIELD SCHOOL BENEFITS TRUST

2018: CHARTERSHIELD SCHOOL BENEFITS TRUST 2018 form 5500 responses
2018-07-01Type of plan entityMulitple employer plan
2018-07-01This submission is the final filingYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: CHARTERSHIELD SCHOOL BENEFITS TRUST 2017 form 5500 responses
2017-07-01Type of plan entityMulitple employer plan
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: CHARTERSHIELD SCHOOL BENEFITS TRUST 2016 form 5500 responses
2016-07-01Type of plan entityMulitple employer plan
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: CHARTERSHIELD SCHOOL BENEFITS TRUST 2015 form 5500 responses
2015-07-01Type of plan entityMulitple employer plan
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-01-01Type of plan entityMulitple employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number281790
Policy instance 2
Insurance contract or identification number281790
Number of Individuals Covered0
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,371,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number281790
Policy instance 1
Insurance contract or identification number281790
Number of Individuals Covered0
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,088,266
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 numberER00033264
Policy instance 3
Insurance contract or identification numberER00033264
Number of Individuals Covered0
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $18,805
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,805
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number279469 ETAL
Policy instance 1
Insurance contract or identification number279469 ETAL
Number of Individuals Covered716
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $283
Total amount of fees paid to insurance companyUSD $6,438
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,830,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number279469 ETAL
Policy instance 2
Insurance contract or identification number279469 ETAL
Number of Individuals Covered3415
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $454
Total amount of fees paid to insurance companyUSD $10,336
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,543,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number280073
Policy instance 3
Insurance contract or identification number280073
Number of Individuals Covered0
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number279469 ETAL
Policy instance 1
Insurance contract or identification number279469 ETAL
Number of Individuals Covered713
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,590
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,031,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,590
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number279469 ETAL
Policy instance 2
Insurance contract or identification number279469 ETAL
Number of Individuals Covered1305
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $256,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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