IAP WORLDWIDE SERVICES, INC. has sponsored the creation of one or more 401k plans.
Additional information about IAP WORLDWIDE SERVICES, INC.
Submission information for form 5500 for 401k plan IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $109,780 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $96,090 |
| Total income from all sources (including contributions) | 2022-12-31 | $11,724,200 |
| Total of all expenses incurred | 2022-12-31 | $11,804,556 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $10,950,787 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $11,722,372 |
| Value of total assets at end of year | 2022-12-31 | $375,520 |
| Value of total assets at beginning of year | 2022-12-31 | $442,186 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $853,769 |
| Total interest from all sources | 2022-12-31 | $1,828 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $4,059,413 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2022-12-31 | $341,987 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $290 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $2 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $27,048 |
| Administrative expenses (other) incurred | 2022-12-31 | $853,769 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-80,356 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $265,740 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $346,096 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Interest earned on other investments | 2022-12-31 | $1,828 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $375,230 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $442,184 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $442,184 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $5,015,862 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $7,662,959 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $5,592,938 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $82,732 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $96,090 |
| Did the plan have assets held for investment | 2022-12-31 | 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 | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2022-12-31 | 581250486 |
| 2021 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $96,090 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $468,276 |
| Total income from all sources (including contributions) | 2021-12-31 | $15,027,115 |
| Total of all expenses incurred | 2021-12-31 | $14,452,982 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $13,287,309 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $15,027,050 |
| Value of total assets at end of year | 2021-12-31 | $442,186 |
| Value of total assets at beginning of year | 2021-12-31 | $240,239 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $1,165,673 |
| Total interest from all sources | 2021-12-31 | $65 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $5,600,812 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2021-12-31 | $373,343 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $2 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $27 |
| Administrative expenses (other) incurred | 2021-12-31 | $1,165,673 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $574,133 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $346,096 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-228,037 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Interest earned on other investments | 2021-12-31 | $65 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $442,184 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $240,212 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $240,212 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $6,560,912 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $9,426,238 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $6,353,054 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $96,090 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $468,276 |
| Did the plan have assets held for investment | 2021-12-31 | 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 | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2021-12-31 | 581250486 |
| 2020 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $468,276 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $14,581 |
| Total income from all sources (including contributions) | 2020-12-31 | $18,724,105 |
| Total of all expenses incurred | 2020-12-31 | $19,286,141 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $17,998,021 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $18,722,563 |
| Value of total assets at end of year | 2020-12-31 | $240,239 |
| Value of total assets at beginning of year | 2020-12-31 | $348,580 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $1,288,120 |
| Total interest from all sources | 2020-12-31 | $1,542 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $7,215,707 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $27 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $565 |
| Administrative expenses (other) incurred | 2020-12-31 | $1,288,120 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-562,036 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $-228,037 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $333,999 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Interest earned on other investments | 2020-12-31 | $1,542 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $240,212 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $348,015 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $348,015 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $8,856,037 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $11,506,856 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $9,141,984 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $468,276 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $14,581 |
| Did the plan have assets held for investment | 2020-12-31 | 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 | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Disclaimer |
| Accountancy firm name | 2020-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2020-12-31 | 581250486 |
| 2019 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $14,581 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $14,581 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $206,097 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $206,097 |
| Total income from all sources (including contributions) | 2019-12-31 | $23,042,438 |
| Total of all expenses incurred | 2019-12-31 | $22,942,438 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $21,581,910 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $21,581,910 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $23,029,901 |
| Value of total assets at end of year | 2019-12-31 | $348,580 |
| Value of total assets at end of year | 2019-12-31 | $348,580 |
| Value of total assets at beginning of year | 2019-12-31 | $440,096 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,360,528 |
| Total interest from all sources | 2019-12-31 | $12,537 |
| Total interest from all sources | 2019-12-31 | $12,537 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $10,000,000 |
| Value of fidelity bond cover | 2019-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $8,022,418 |
| Contributions received from participants | 2019-12-31 | $8,022,418 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $565 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $304 |
| Administrative expenses (other) incurred | 2019-12-31 | $1,360,528 |
| Administrative expenses (other) incurred | 2019-12-31 | $1,360,528 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $0 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $45,143 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $100,000 |
| Value of net income/loss | 2019-12-31 | $100,000 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $333,999 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $333,999 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $233,999 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Interest earned on other investments | 2019-12-31 | $12,537 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $348,015 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $348,015 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $439,792 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $439,792 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $10,058,333 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $10,058,333 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $15,007,483 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $11,523,577 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $11,523,577 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $14,581 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $14,581 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $160,954 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | 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 | 2019-12-31 | 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 | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
| Accountancy firm name | 2019-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm name | 2019-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2019-12-31 | 581250486 |
| 2018 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $206,097 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $173,785 |
| Total income from all sources (including contributions) | 2018-12-31 | $19,600,133 |
| Total of all expenses incurred | 2018-12-31 | $20,130,793 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $18,972,306 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $19,597,027 |
| Value of total assets at end of year | 2018-12-31 | $440,096 |
| Value of total assets at beginning of year | 2018-12-31 | $938,444 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $1,158,487 |
| Total interest from all sources | 2018-12-31 | $3,106 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $7,154,156 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $304 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $183 |
| Administrative expenses (other) incurred | 2018-12-31 | $1,158,487 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $45,143 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-530,660 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $233,999 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $764,659 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Interest earned on other investments | 2018-12-31 | $3,106 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $439,792 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $938,261 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $938,261 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $8,970,714 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $12,442,871 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $10,001,592 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $160,954 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $173,785 |
| Did the plan have assets held for investment | 2018-12-31 | 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 | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Disclaimer |
| Accountancy firm name | 2018-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2018-12-31 | 581250486 |
| 2017 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $173,785 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $327,164 |
| Total income from all sources (including contributions) | 2017-12-31 | $15,768,409 |
| Total of all expenses incurred | 2017-12-31 | $14,993,762 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $14,055,464 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $15,763,583 |
| Value of total assets at end of year | 2017-12-31 | $938,444 |
| Value of total assets at beginning of year | 2017-12-31 | $317,176 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $938,298 |
| Total interest from all sources | 2017-12-31 | $4,826 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $5,587,752 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $183 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $76 |
| Administrative expenses (other) incurred | 2017-12-31 | $938,298 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $54,818 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $774,647 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $764,659 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-9,988 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Interest earned on other investments | 2017-12-31 | $4,826 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $938,261 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $317,100 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $317,100 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $7,478,175 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $10,175,831 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $6,577,289 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $173,785 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $272,346 |
| Did the plan have assets held for investment | 2017-12-31 | 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 | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Disclaimer |
| Accountancy firm name | 2017-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2017-12-31 | 581250486 |
| 2016 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $327,164 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $48,639 |
| Total income from all sources (including contributions) | 2016-12-31 | $16,581,988 |
| Total of all expenses incurred | 2016-12-31 | $16,678,018 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $15,788,551 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $16,581,807 |
| Value of total assets at end of year | 2016-12-31 | $317,176 |
| Value of total assets at beginning of year | 2016-12-31 | $134,681 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $889,467 |
| Total interest from all sources | 2016-12-31 | $181 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $5,543,151 |
| Participant contributions at end of year | 2016-12-31 | $0 |
| Participant contributions at beginning of year | 2016-12-31 | $2,341 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $76 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $2 |
| Administrative expenses (other) incurred | 2016-12-31 | $889,467 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $54,818 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $-96,030 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $-9,988 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $86,042 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Interest earned on other investments | 2016-12-31 | $181 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $317,100 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $132,338 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $132,338 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $7,501,219 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $11,038,656 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $8,287,332 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $272,346 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $48,639 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| 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 | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2016-12-31 | 581250486 |
| 2015 : IAP WORLDWIDE SERVICES, INC EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $48,639 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $169,642 |
| Total income from all sources (including contributions) | 2015-12-31 | $12,150,827 |
| Total of all expenses incurred | 2015-12-31 | $12,371,901 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $11,573,776 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $12,150,799 |
| Value of total assets at end of year | 2015-12-31 | $134,681 |
| Value of total assets at beginning of year | 2015-12-31 | $476,758 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $798,125 |
| Total interest from all sources | 2015-12-31 | $28 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $4,423,758 |
| Participant contributions at end of year | 2015-12-31 | $2,341 |
| Participant contributions at beginning of year | 2015-12-31 | $5,873 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $2 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $6 |
| Administrative expenses (other) incurred | 2015-12-31 | $798,125 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-221,074 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $86,042 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $307,116 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Interest earned on other investments | 2015-12-31 | $28 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $132,338 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $470,879 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $470,879 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $5,562,848 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $7,727,041 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $6,010,928 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $48,639 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $169,642 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| 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 | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2015-12-31 | 581250486 |
| 2014 : IAP WORLDWIDE SERVICES, INC EMPLOYEE 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 | $169,642 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $49,787 |
| Total income from all sources (including contributions) | 2014-12-31 | $11,677,990 |
| Total of all expenses incurred | 2014-12-31 | $12,834,495 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $12,088,356 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $11,677,880 |
| Value of total assets at end of year | 2014-12-31 | $476,758 |
| Value of total assets at beginning of year | 2014-12-31 | $1,513,408 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $746,139 |
| Total interest from all sources | 2014-12-31 | $110 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $5,000,000 |
| 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 | $4,528,447 |
| Participant contributions at end of year | 2014-12-31 | $5,873 |
| Participant contributions at beginning of year | 2014-12-31 | $12,617 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $6 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $14 |
| Administrative expenses (other) incurred | 2014-12-31 | $746,139 |
| 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 | $-1,156,505 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $307,116 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $1,463,621 |
| 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 |
| Interest earned on other investments | 2014-12-31 | $110 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $470,879 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $1,500,777 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $1,500,777 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $5,457,013 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| 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 | $7,149,433 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $6,631,343 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $169,642 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $49,787 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| 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 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2014-12-31 | 581250486 |
| 2013 : IAP WORLDWIDE SERVICES, INC EMPLOYEE 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 | $49,787 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $42,937 |
| Total income from all sources (including contributions) | 2013-12-31 | $11,974,463 |
| Total of all expenses incurred | 2013-12-31 | $12,947,759 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $12,183,844 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $11,974,245 |
| Value of total assets at end of year | 2013-12-31 | $1,513,408 |
| Value of total assets at beginning of year | 2013-12-31 | $2,479,854 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $763,915 |
| Total interest from all sources | 2013-12-31 | $218 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| 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 | $4,685,979 |
| Participant contributions at end of year | 2013-12-31 | $12,617 |
| Participant contributions at beginning of year | 2013-12-31 | $237,878 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $14 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $95 |
| Administrative expenses (other) incurred | 2013-12-31 | $763,915 |
| 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 | $-973,296 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $1,463,621 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $2,436,917 |
| 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 |
| Interest earned on other investments | 2013-12-31 | $218 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $1,500,777 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $2,213,188 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $2,213,188 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $6,545,499 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| 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 | $7,288,266 |
| Employer contributions (assets) at end of year | 2013-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $28,693 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $5,638,345 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $49,787 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $42,937 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| 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 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Disclaimer |
| Accountancy firm name | 2013-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2013-12-31 | 581250486 |
| 2012 : IAP WORLDWIDE SERVICES, INC EMPLOYEE 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 | $42,937 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $51,000 |
| Total income from all sources (including contributions) | 2012-12-31 | $15,578,727 |
| Total of all expenses incurred | 2012-12-31 | $15,984,517 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $15,095,534 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $15,578,370 |
| Value of total assets at end of year | 2012-12-31 | $2,479,854 |
| Value of total assets at beginning of year | 2012-12-31 | $2,893,707 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $888,983 |
| Total interest from all sources | 2012-12-31 | $357 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| 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 | $6,059,353 |
| Participant contributions at end of year | 2012-12-31 | $237,878 |
| Participant contributions at beginning of year | 2012-12-31 | $299,073 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $95 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $121 |
| Administrative expenses (other) incurred | 2012-12-31 | $888,983 |
| 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 | $-405,790 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $2,436,917 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,842,707 |
| 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 |
| Interest earned on other investments | 2012-12-31 | $357 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $2,213,188 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $2,332,003 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $2,332,003 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $7,537,344 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| 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 | $9,519,017 |
| Employer contributions (assets) at end of year | 2012-12-31 | $28,693 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $262,510 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $7,558,190 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $42,937 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $51,000 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| 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 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2012-12-31 | 581250486 |
| 2011 : IAP WORLDWIDE SERVICES, INC EMPLOYEE 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 | $51,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $76,274 |
| Total income from all sources (including contributions) | 2011-12-31 | $19,801,547 |
| Total of all expenses incurred | 2011-12-31 | $19,817,798 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $18,648,591 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $19,801,198 |
| Value of total assets at end of year | 2011-12-31 | $2,893,707 |
| Value of total assets at beginning of year | 2011-12-31 | $2,935,232 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $1,169,207 |
| Total interest from all sources | 2011-12-31 | $349 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| 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 | $7,558,397 |
| Participant contributions at end of year | 2011-12-31 | $299,073 |
| Participant contributions at beginning of year | 2011-12-31 | $364,859 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $121 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $18,034 |
| Administrative expenses (other) incurred | 2011-12-31 | $1,169,207 |
| 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 | $-16,251 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $2,842,707 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,858,958 |
| 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 |
| Interest earned on other investments | 2011-12-31 | $349 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $2,332,003 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $1,839,102 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $1,839,102 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $8,535,558 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| 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 | $12,242,801 |
| Employer contributions (assets) at end of year | 2011-12-31 | $262,510 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $713,237 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $10,113,033 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $51,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $76,274 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| 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 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2011-12-31 | 581250486 |
| 2010 : IAP WORLDWIDE SERVICES, INC EMPLOYEE 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 | $76,274 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $199,049 |
| Total income from all sources (including contributions) | 2010-12-31 | $23,545,997 |
| Total of all expenses incurred | 2010-12-31 | $23,432,970 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $22,125,615 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $23,545,694 |
| Value of total assets at end of year | 2010-12-31 | $2,935,232 |
| Value of total assets at beginning of year | 2010-12-31 | $2,944,980 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $1,307,355 |
| Total interest from all sources | 2010-12-31 | $303 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| 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 | $8,081,490 |
| Participant contributions at end of year | 2010-12-31 | $364,859 |
| Participant contributions at beginning of year | 2010-12-31 | $259,420 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $18,034 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $18,902 |
| Administrative expenses (other) incurred | 2010-12-31 | $1,307,355 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $63,165 |
| 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 | $113,027 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $2,858,958 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,745,931 |
| 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 |
| Interest earned on other investments | 2010-12-31 | $303 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $1,839,102 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $1,943,302 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $1,943,302 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $8,647,878 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| 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 | $15,464,204 |
| Employer contributions (assets) at end of year | 2010-12-31 | $713,237 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $723,356 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $13,477,737 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $76,274 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $135,884 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| 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 | SMITH & HOWARD, P.C. |
| Accountancy firm EIN | 2010-12-31 | 581250486 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 20 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 901 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | 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 | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 18 | | 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 $124,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | ANNUAL BOB |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $2 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $11,409 | | 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 | | Amount paid for insurance broker fees | 11409 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $12,033 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12033 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $9,343 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9343 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $2,114 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2114 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2023-01-01 | | Total amount of fees paid to insurance company | USD $397 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 397 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 7 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK963583 |
| Policy instance | 19 |
| Insurance contract or identification number | OK963583 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $85,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750440 |
| Policy instance | 18 |
| Insurance contract or identification number | LK750440 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $236,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 17 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $333,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 16 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $361,502 | | 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 |
| Policy instance | 15 |
| Insurance contract or identification number | EXRK | | Number of Individuals Covered | 272 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $26,631 | | Other welfare benefits provided | AGGREGATE & INDIVIDUAL EXCESS RISK | | Welfare Benefit Premiums Paid to Carrier | USD $468,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,631 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60816-99 |
| Policy instance | 14 |
| Insurance contract or identification number | 71-60816-99 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 442 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $648,293 | | 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 | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 442 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $56,535 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $2,993,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,535 | | Additional information about fees paid to insurance broker | SALES & SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 927 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $872,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of fees paid to insurance company | USD $264 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $14,098 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 264 | | Additional information about fees paid to insurance broker | SALES & SERVICE | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of fees paid to insurance company | USD $2,116 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $8,240 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2116 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of fees paid to insurance company | USD $9,661 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9661 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of fees paid to insurance company | USD $12,475 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,130 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12475 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $5,428 | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 645 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2022-01-01 | | Total amount of fees paid to insurance company | USD $10,493 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 10493 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 18 | | 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 $246,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | ANNUAL BOB |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 17 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $485,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK750440 |
| Policy instance | 18 |
| Insurance contract or identification number | LK750440 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $378,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK963583 |
| Policy instance | 19 |
| Insurance contract or identification number | OK963583 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $56,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60816-99 |
| Policy instance | 14 |
| Insurance contract or identification number | 71-60816-99 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 16 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $448,120 | | 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 | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 927 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $71,741 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $3,835,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $71,741 | | Additional information about fees paid to insurance broker | SALES & SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 20 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $589 | | 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 |
| Policy instance | 15 |
| Insurance contract or identification number | EXRK | | Number of Individuals Covered | 304 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $49,596 | | Other welfare benefits provided | AGGREGATE & INDIVIDUAL EXCESS RISK | | Welfare Benefit Premiums Paid to Carrier | USD $628,249 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,596 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 986 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | 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 | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $4,071 | | 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 |
| Policy instance | 15 |
| Insurance contract or identification number | EXRK | | Number of Individuals Covered | 534 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $54,680 | | Other welfare benefits provided | AGGREGATE & INDIVIDUAL EXCESS RISK | | Welfare Benefit Premiums Paid to Carrier | USD $677,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,680 | | Additional information about fees paid to insurance broker | SUPP COMPENSATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1647 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $640 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $452,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 640 | | Additional information about fees paid to insurance broker | ANNUAL BOB |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1155 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of fees paid to insurance company | USD $2,042 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $105,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2042 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of fees paid to insurance company | USD $5 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $10,134 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $524,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 10134 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of fees paid to insurance company | USD $11,917 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $630,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 11917 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2021-01-01 | | Total amount of fees paid to insurance company | USD $9,699 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $489,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9699 | | Additional information about fees paid to insurance broker | SALES AND SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1022 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of fees paid to insurance company | USD $91,282 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $6,393,135 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 91282 | | Additional information about fees paid to insurance broker | SALES & SERVICES | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1022 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,308,590 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60816-99 |
| Policy instance | 14 |
| Insurance contract or identification number | 71-60816-99 | | Number of Individuals Covered | 533 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $115,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $584,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $741,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $652,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2020-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $8,143 | | 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 | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 966 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $6,911,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 966 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,090,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60816-99 |
| Policy instance | 14 |
| Insurance contract or identification number | 71-60816-99 | | Number of Individuals Covered | 795 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | 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 | 71062-8 |
| Policy instance | 15 |
| Insurance contract or identification number | 71062-8 | | Number of Individuals Covered | 795 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $40,551 | | Other welfare benefits provided | AGGREGATE & INDIVIDUAL EXCESS RISK | | Welfare Benefit Premiums Paid to Carrier | USD $775,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,551 | | Additional information about fees paid to insurance broker | SUPP COMPENSATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 2238 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1396 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of fees paid to insurance company | USD $460 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $251,894 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 460 |
|
| WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 ) |
| Policy contract number | ESL 1000703 01 |
| Policy instance | 14 |
| Insurance contract or identification number | ESL 1000703 01 | | Number of Individuals Covered | 754 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $597,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 2452 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | 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 | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $4,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $1,895 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $252,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1895 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1373 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $396,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $60,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-07-01 | | Total amount of fees paid to insurance company | USD $269 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 269 | | Insurance broker organization code? | 7 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1117 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $5,064,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $351,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60816-99 |
| Policy instance | 16 |
| Insurance contract or identification number | 71-60816-99 | | Number of Individuals Covered | 762 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 12135 ) |
| Policy contract number | CB350 |
| Policy instance | 15 |
| Insurance contract or identification number | CB350 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $361,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1117 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $736,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1357 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $23,721 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 23721 | | Insurance broker name | DELTA DENTAL INSURANCE COMPANY |
|
| WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 ) |
| Policy contract number | ESL 800000600 |
| Policy instance | 14 |
| Insurance contract or identification number | ESL 800000600 | | Number of Individuals Covered | 456 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $448,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1386 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $673,892 | | 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 | 02906A |
| Policy instance | 12 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 1386 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $4,398,783 | | 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 | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $102 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $102 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS. SERV. USA INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERVICES |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $1,704 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $79,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1704 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERVICE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $8,697 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $416,038 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 8697 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERVICE |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-60573 |
| Policy instance | 15 |
| Insurance contract or identification number | 71-60573 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $10,928 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $501,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 10928 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERVICE |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $9,053 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $441,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9053 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of fees paid to insurance company | USD $4 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERVICE |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1054 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $636 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $293,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 636 | | Insurance broker name | WELLS FARGO INS SERVICES USA INC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $8,143 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 12135 ) |
| Policy contract number | CB350 |
| Policy instance | 16 |
| Insurance contract or identification number | CB350 | | Number of Individuals Covered | 883 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $3 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 71-60573 |
| Policy instance | 15 |
| Insurance contract or identification number | 71-60573 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1259 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $22,341 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 22341 | | Insurance broker name | DELTA DENTAL INSURANCE COMPANY |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $4,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 87 | | 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 $422,823 | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1642 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $18,185 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 18185 | | Insurance broker name | VISION SERVICE PLAN |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $3,789 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $342,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3789 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $3,903 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $319,104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3903 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $2,825 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $252,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2825 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $615 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $54,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 615 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,431 | | 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 | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $248 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,838 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $248 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS. SERV. USA INC. |
|
| STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
| Policy contract number | SSLIHCRS0048115 |
| Policy instance | 12 |
| Insurance contract or identification number | SSLIHCRS0048115 | | Number of Individuals Covered | 496 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $250,695 | | 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 | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 639 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $3,085,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 14 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 639 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $444,019 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD SECURITY LIFE (National Association of Insurance Commissioners NAIC id number: 69078 ) |
| Policy contract number | SSLIHCRS0048114 |
| Policy instance | 12 |
| Insurance contract or identification number | SSLIHCRS0048114 | | Number of Individuals Covered | 505 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $136,541 | | 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 | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 466 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $3,627,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 14 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 466 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $460,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-07-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $378,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $61,545 | | 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 | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-13 | | Total amount of commissions paid to insurance broker | USD $87 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,557 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS. SERV. USA INC. |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $282,477 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $390,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 86 | | 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 $488,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $286 | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 749 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $19,498 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 19498 | | Insurance broker name | VISION SERVICE PLAN |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | MEDICAL BENEFITS ABROAD | | Welfare Benefit Premiums Paid to Carrier | USD $24,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1298 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $24,738 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 24738 | | Insurance broker name | DELTA DENTAL INSURANCE COMPANY |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 91 | | 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 $502,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 02906A |
| Policy instance | 13 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 760 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $3,827,568 | | 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 | 02906A |
| Policy instance | 15 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 760 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVAC, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $325,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 02906A |
| Policy instance | 14 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 760 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $510,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of fees paid to insurance company | USD $7,743 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $419,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7743 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER. |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 892 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $19,437 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 19437 | | Insurance broker name | VISION SERVICE PLAN |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of fees paid to insurance company | USD $16 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER. |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1358 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $23,750 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 23750 | | Insurance broker name | DELTA DENTAL INSURANCE COMPANY |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of fees paid to insurance company | USD $5,563 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $346,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5563 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of fees paid to insurance company | USD $1,365 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $77,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1365 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of fees paid to insurance company | USD $208 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $13,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 208 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INS SERV. USA INC |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | MNLIHCRS0000813 |
| Policy instance | 12 |
| Insurance contract or identification number | MNLIHCRS0000813 | | Number of Individuals Covered | 460 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $118,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of fees paid to insurance company | USD $6,304 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $389,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6304 | | Insurance broker organization code? | 7 | | Insurance broker name | WELLS FARGO INSURANCE SER |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,920 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $842,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,920 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 1737 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | MNL-2012-002 |
| Policy instance | 12 |
| Insurance contract or identification number | MNL-2012-002 | | Number of Individuals Covered | 600 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $186,104 | | 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 | 02906C |
| Policy instance | 2 |
| Insurance contract or identification number | 02906C | | Number of Individuals Covered | 1 | | 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 $20,377 | | 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 | 3327 |
| Policy instance | 11 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 10 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $2,750 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $14,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,750 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 9 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $1,495 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $84,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,495 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 8 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $6,157 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $344,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,157 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 7 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $8,396 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $480,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,396 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 6 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $6,658 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $388,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,658 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 5 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $18 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SVCS USA |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 4 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1005 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Vision 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-2 |
| Policy instance | 6 |
| Insurance contract or identification number | 17318-2 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-4 |
| Policy instance | 7 |
| Insurance contract or identification number | 17318-4 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-6 |
| Policy instance | 8 |
| Insurance contract or identification number | 17318-6 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-7 |
| Policy instance | 9 |
| Insurance contract or identification number | 17318-7 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-9 |
| Policy instance | 10 |
| Insurance contract or identification number | 17318-9 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 5 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1435 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Vision 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-1 |
| Policy instance | 4 |
| Insurance contract or identification number | 17318-1 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $701 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-0 |
| Policy instance | 3 |
| Insurance contract or identification number | 17318-0 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $19,405 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $394,861 | | 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 | 02906A |
| Policy instance | 2 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 832 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $309,782 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION, EAP | | Welfare Benefit Premiums Paid to Carrier | USD $4,841,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 2319 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Dental 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 | 3327 |
| Policy instance | 26 |
| Insurance contract or identification number | 3327 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-17 |
| Policy instance | 22 |
| Insurance contract or identification number | 17318-17 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,414 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $128,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-11 |
| Policy instance | 11 |
| Insurance contract or identification number | 17318-11 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $18,919 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $374,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-5 |
| Policy instance | 12 |
| Insurance contract or identification number | 17318-5 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,137 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,140 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-22 |
| Policy instance | 34 |
| Insurance contract or identification number | 17318-22 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-21 |
| Policy instance | 33 |
| Insurance contract or identification number | 17318-21 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-20 |
| Policy instance | 32 |
| Insurance contract or identification number | 17318-20 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-19 |
| Policy instance | 31 |
| Insurance contract or identification number | 17318-19 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-18 |
| Policy instance | 24 |
| Insurance contract or identification number | 17318-18 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $885 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-12 |
| Policy instance | 29 |
| Insurance contract or identification number | 17318-12 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-3 |
| Policy instance | 28 |
| Insurance contract or identification number | 17318-3 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-13 |
| Policy instance | 30 |
| Insurance contract or identification number | 17318-13 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | ABL962474 |
| Policy instance | 25 |
| Insurance contract or identification number | ABL962474 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-07-01 | | Total amount of commissions paid to insurance broker | USD $2,437 | | Total amount of fees paid to insurance company | USD $325 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $16,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIDELITY SECURITY LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | SE1E0104 |
| Policy instance | 27 |
| Insurance contract or identification number | SE1E0104 | | Number of Individuals Covered | 806 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $12,132 | | Welfare Benefit Premiums Paid to Carrier | USD $242,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-10 |
| Policy instance | 35 |
| Insurance contract or identification number | 17318-10 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 16 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $15,383 | | Total amount of fees paid to insurance company | USD $10,675 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $512,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 15 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $473 | | Total amount of fees paid to insurance company | USD $30 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-15 |
| Policy instance | 14 |
| Insurance contract or identification number | 17318-15 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $21,377 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $411,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-14 |
| Policy instance | 13 |
| Insurance contract or identification number | 17318-14 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $877 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 17 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $19,440 | | Total amount of fees paid to insurance company | USD $14,437 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $647,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 18 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $15,171 | | Total amount of fees paid to insurance company | USD $9,676 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $505,536 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 19 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2012-01-01 | | Total amount of commissions paid to insurance broker | USD $3,686 | | Total amount of fees paid to insurance company | USD $2,675 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $118,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-8 |
| Policy instance | 20 |
| Insurance contract or identification number | 17318-8 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $480 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-16 |
| Policy instance | 21 |
| Insurance contract or identification number | 17318-16 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,504 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 23 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $75,696 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,493,791 | | 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: 32395 ) |
| Policy contract number | 05113046 |
| Policy instance | 12 |
| Insurance contract or identification number | 05113046 | | Number of Individuals Covered | 1618 | | 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 | | Vision 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 | 33494-7005 |
| Policy instance | 11 |
| Insurance contract or identification number | 33494-7005 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-1 |
| Policy instance | 9 |
| Insurance contract or identification number | 17318-1 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $190 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $190 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-0 |
| Policy instance | 8 |
| Insurance contract or identification number | 17318-0 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,698 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $329,673 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,698 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-4900 |
| Policy instance | 7 |
| Insurance contract or identification number | 33494-4900 | | 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 | | Health 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 | 33494-0005 |
| Policy instance | 6 |
| Insurance contract or identification number | 33494-0005 | | 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 | | Health 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 | 33494-0004 |
| Policy instance | 5 |
| Insurance contract or identification number | 33494-0004 | | 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 | | Health 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 | 33494-7003 |
| Policy instance | 3 |
| Insurance contract or identification number | 33494-7003 | | 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 $1,097 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,097 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-0003 |
| Policy instance | 2 |
| Insurance contract or identification number | 33494-0003 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $56,479 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,546,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,479 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 10-03718 |
| Policy instance | 1 |
| Insurance contract or identification number | 10-03718 | | Number of Individuals Covered | 2784 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX961993 |
| Policy instance | 31 |
| Insurance contract or identification number | FLX961993 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $23,525 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $784,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,525 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-7004 |
| Policy instance | 10 |
| Insurance contract or identification number | 33494-7004 | | 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 | | Health Insurance Welfare Benefit | Yes | | 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 | 02906A |
| Policy instance | 4 |
| Insurance contract or identification number | 02906A | | Number of Individuals Covered | 873 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $239,067 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EVACUATION | | Welfare Benefit Premiums Paid to Carrier | USD $3,142,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $239,067 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-2 |
| Policy instance | 13 |
| Insurance contract or identification number | 17318-2 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-4 |
| Policy instance | 14 |
| Insurance contract or identification number | 17318-4 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-6 |
| Policy instance | 15 |
| Insurance contract or identification number | 17318-6 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-15 |
| Policy instance | 28 |
| Insurance contract or identification number | 17318-15 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,682 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $397,801 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,682 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | TDI960165 |
| Policy instance | 29 |
| Insurance contract or identification number | TDI960165 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $40 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,335 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLK960281 |
| Policy instance | 30 |
| Insurance contract or identification number | FLK960281 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $17,344 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $578,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,344 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 963583 |
| Policy instance | 33 |
| Insurance contract or identification number | OK 963583 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $4,359 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH | | Welfare Benefit Premiums Paid to Carrier | USD $145,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,359 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-8 |
| Policy instance | 34 |
| Insurance contract or identification number | 17318-8 | | 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 $225 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $225 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-16 |
| Policy instance | 35 |
| Insurance contract or identification number | 17318-16 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,866 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,866 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-17 |
| Policy instance | 36 |
| Insurance contract or identification number | 17318-17 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,229 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,229 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318 |
| Policy instance | 37 |
| Insurance contract or identification number | 17318 | | Number of Individuals Covered | 388 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $26,470 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,503,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,470 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-18 |
| Policy instance | 38 |
| Insurance contract or identification number | 17318-18 | | Number of Individuals Covered | 4 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| 5 STAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77879 ) |
| Policy contract number | GE421628757 |
| Policy instance | 39 |
| Insurance contract or identification number | GE421628757 | | Number of Individuals Covered | 737 | | Insurance policy start date | 2009-10-31 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $284,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-14 |
| Policy instance | 27 |
| Insurance contract or identification number | 17318-14 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $378 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,299 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $378 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-7008 |
| Policy instance | 26 |
| Insurance contract or identification number | 33494-7008 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-7 |
| Policy instance | 16 |
| Insurance contract or identification number | 17318-7 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-9 |
| Policy instance | 17 |
| Insurance contract or identification number | 17318-9 | | 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 | | Health 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 PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-11 |
| Policy instance | 18 |
| Insurance contract or identification number | 17318-11 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,132 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $354,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,132 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17318-5 |
| Policy instance | 19 |
| Insurance contract or identification number | 17318-5 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,070 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $165,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,070 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494 |
| Policy instance | 20 |
| Insurance contract or identification number | 33494 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $77,605 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,132,512 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,605 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-0006 |
| Policy instance | 21 |
| Insurance contract or identification number | 33494-0006 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-0007 |
| Policy instance | 22 |
| Insurance contract or identification number | 33494-0007 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $906 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,289 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $906 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-0008 |
| Policy instance | 23 |
| Insurance contract or identification number | 33494-0008 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,457 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,457 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-7006 |
| Policy instance | 24 |
| Insurance contract or identification number | 33494-7006 | | 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 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 33494-7007 |
| Policy instance | 25 |
| Insurance contract or identification number | 33494-7007 | | 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 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 750440 |
| Policy instance | 32 |
| Insurance contract or identification number | LK 750440 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2011-01-01 | | Total amount of commissions paid to insurance broker | USD $15,656 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $521,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,656 | | Insurance broker organization code? | 3 | | Insurance broker name | CRAFORD & CRAFORD |
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