MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: MCWAH DENTAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 887 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 864 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 1 |
| Total of all active and inactive participants | 2022-07-01 | 865 |
| 2021: MCWAH DENTAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 871 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 886 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 1 |
| Total of all active and inactive participants | 2021-07-01 | 887 |
| 2020: MCWAH DENTAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 875 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 870 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 1 |
| Total of all active and inactive participants | 2020-07-01 | 871 |
| 2019: MCWAH DENTAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 853 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 872 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 3 |
| Total of all active and inactive participants | 2019-07-01 | 875 |
| 2018: MCWAH DENTAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 839 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 852 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 1 |
| Total of all active and inactive participants | 2018-07-01 | 853 |
| 2017: MCWAH DENTAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 806 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 839 |
| Total of all active and inactive participants | 2017-07-01 | 839 |
| 2016: MCWAH DENTAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 798 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 803 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 3 |
| Total of all active and inactive participants | 2016-07-01 | 806 |
| 2015: MCWAH DENTAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 729 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 794 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 4 |
| Total of all active and inactive participants | 2015-07-01 | 798 |
| 2014: MCWAH DENTAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 735 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 724 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 5 |
| Total of all active and inactive participants | 2014-07-01 | 729 |
| 2013: MCWAH DENTAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 721 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 732 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 0 |
| Total of all active and inactive participants | 2013-07-01 | 735 |
| 2012: MCWAH DENTAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 709 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 713 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
| Total of all active and inactive participants | 2012-07-01 | 721 |
| 2011: MCWAH DENTAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 701 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 706 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 709 |
| 2010: MCWAH DENTAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 683 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 697 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 701 |
| 2009: MCWAH DENTAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 682 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 677 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 683 |
| 2022: MCWAH DENTAL PLAN 2022 form 5500 responses |
|---|
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MCWAH DENTAL PLAN 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MCWAH DENTAL PLAN 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MCWAH DENTAL PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MCWAH DENTAL PLAN 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MCWAH DENTAL PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MCWAH DENTAL PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MCWAH DENTAL PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MCWAH DENTAL PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MCWAH DENTAL PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MCWAH DENTAL PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MCWAH DENTAL PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MCWAH DENTAL PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MCWAH DENTAL PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 286 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $2,980 | | Total amount of fees paid to insurance company | USD $0 | | 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 $2,980 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 578 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $5,516 | | Total amount of fees paid to insurance company | USD $0 | | 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 $5,516 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $3,200 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,200 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $5,665 | | Total amount of fees paid to insurance company | USD $0 | | 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 $5,665 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 367 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $3,769 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,769 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 503 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $4,669 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4,669 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 497 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $4,847 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4,847 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $3,606 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,606 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 503 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $5,244 | | Total amount of fees paid to insurance company | USD $0 | | 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 $5,244 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 350 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $3,422 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,422 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 334 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $3,463 | | Total amount of fees paid to insurance company | USD $0 | | 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 $3,463 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 505 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $5,187 | | Total amount of fees paid to insurance company | USD $0 | | 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 $5,187 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $4,057 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4,057 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $4,310 | | Total amount of fees paid to insurance company | USD $0 | | 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 $4,310 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $4,017 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,017 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 381 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $4,154 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,154 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,886 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,886 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $4,265 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,265 | | Insurance broker organization code? | 3 | | Insurance broker name | WI MEDICAL SOCIETY INSURANCE |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $4,529 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,529 | | Insurance broker organization code? | 3 | | Insurance broker name | PETRETTI & ASSOCIATES INC. |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $3,455 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,455 | | Insurance broker organization code? | 3 | | Insurance broker name | PETRETTI & ASSOCIATES INC. |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 298 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $3,210 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 410 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $4,803 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 10302 00000 |
| Policy instance | 1 |
| Insurance contract or identification number | 10302 00000 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $3,387 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 ) |
| Policy contract number | 03905 00000 |
| Policy instance | 2 |
| Insurance contract or identification number | 03905 00000 | | Number of Individuals Covered | 391 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $4,629 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
