COTTONWOOD, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COTTONWOOD, INC. HEALTH INSURANCE PLAN
401k plan membership statisitcs for COTTONWOOD, INC. HEALTH INSURANCE PLAN
Measure | Date | Value |
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2022: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 137 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 140 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
Total of all active and inactive participants | 2022-01-01 | 141 |
2021: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 169 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 137 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
Total of all active and inactive participants | 2021-01-01 | 139 |
2019: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 181 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 176 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 2 |
Total of all active and inactive participants | 2019-01-01 | 178 |
Total participants | 2019-01-01 | 178 |
Number of participants with account balances | 2019-01-01 | 0 |
2018: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 179 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 2 |
Total of all active and inactive participants | 2018-01-01 | 181 |
Total participants | 2018-01-01 | 181 |
2017: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 169 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
Total of all active and inactive participants | 2017-01-01 | 170 |
Total participants | 2017-01-01 | 170 |
2016: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 198 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 166 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 4 |
Total of all active and inactive participants | 2016-01-01 | 170 |
Total participants | 2016-01-01 | 170 |
2015: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 189 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 195 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 3 |
Total of all active and inactive participants | 2015-01-01 | 198 |
Total participants | 2015-01-01 | 0 |
2014: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 196 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 185 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 4 |
Total of all active and inactive participants | 2014-01-01 | 189 |
Total participants | 2014-01-01 | 0 |
2013: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 58 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 191 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 5 |
Total of all active and inactive participants | 2013-01-01 | 196 |
Total participants | 2013-01-01 | 0 |
2012: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 50 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 58 |
Total of all active and inactive participants | 2012-01-01 | 58 |
Total participants | 2012-01-01 | 0 |
2011: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 48 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 50 |
Total of all active and inactive participants | 2011-01-01 | 50 |
Total participants | 2011-01-01 | 50 |
2009: COTTONWOOD, INC. HEALTH INSURANCE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 123 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 114 |
Total of all active and inactive participants | 2009-01-01 | 114 |
Total participants | 2009-01-01 | 114 |
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0175933 |
Policy instance | 4 |
Insurance contract or identification number | 0175933 | Number of Individuals Covered | 168 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $8,880 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $926,081 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 8880 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98649191001 |
Policy instance | 1 |
Insurance contract or identification number | 98649191001 | Number of Individuals Covered | 211 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,397 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,951 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,397 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 111 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,458 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,528 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,458 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 54359-000-00001 |
Policy instance | 3 |
Insurance contract or identification number | 54359-000-00001 | Number of Individuals Covered | 37 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,738 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,738 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 5 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $343 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 54359-000-00001 |
Policy instance | 3 |
Insurance contract or identification number | 54359-000-00001 | Number of Individuals Covered | 48 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,246 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,196 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,246 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 101 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,945 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $47,324 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,945 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98649191001 |
Policy instance | 1 |
Insurance contract or identification number | 98649191001 | Number of Individuals Covered | 220 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,703 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,703 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 07729 |
Policy instance | 4 |
Insurance contract or identification number | 07729 | Number of Individuals Covered | 170 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $21,719 | 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 | Commission paid to Insurance Broker | USD $21,719 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98649191001 |
Policy instance | 1 |
Insurance contract or identification number | 98649191001 | Number of Individuals Covered | 234 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,610 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,034 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,610 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 107 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $3,851 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,970 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,851 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0108847 |
Policy instance | 4 |
Insurance contract or identification number | 0108847 | Number of Individuals Covered | 194 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $39,097 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,060,165 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $39,097 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 54359-000-00001 |
Policy instance | 3 |
Insurance contract or identification number | 54359-000-00001 | Number of Individuals Covered | 54 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,538 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,538 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 171 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $5,444 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,775 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,444 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) |
Policy contract number | 09517 |
Policy instance | 3 |
Insurance contract or identification number | 09517 | Number of Individuals Covered | 216 | 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 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98649191001 |
Policy instance | 1 |
Insurance contract or identification number | 98649191001 | Number of Individuals Covered | 237 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,683 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,683 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5051150000 |
Policy instance | 3 |
Insurance contract or identification number | 5051150000 | Number of Individuals Covered | 194 | Total amount of commissions paid to insurance broker | USD $16,765 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $917,451 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,765 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9864919 |
Policy instance | 1 |
Insurance contract or identification number | 9864919 | Number of Individuals Covered | 221 | Total amount of commissions paid to insurance broker | USD $1,595 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,887 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,595 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 170 | Total amount of commissions paid to insurance broker | USD $5,937 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,937 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 169 | Total amount of commissions paid to insurance broker | USD $5,766 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,785 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,766 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5051150000 |
Policy instance | 3 |
Insurance contract or identification number | 5051150000 | Number of Individuals Covered | 197 | Total amount of commissions paid to insurance broker | USD $23,428 | Total amount of fees paid to insurance company | USD $15,226 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $780,922 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,428 | Amount paid for insurance broker fees | 15226 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9864919 |
Policy instance | 1 |
Insurance contract or identification number | 9864919 | Number of Individuals Covered | 231 | Total amount of commissions paid to insurance broker | USD $1,495 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,267 | 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 | BUKATY COMPANIES |
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CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5051150000 |
Policy instance | 3 |
Insurance contract or identification number | 5051150000 | Number of Individuals Covered | 201 | Total amount of commissions paid to insurance broker | USD $30,286 | Total amount of fees paid to insurance company | USD $14,567 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $757,153 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,286 | Amount paid for insurance broker fees | 14567 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 169 | Total amount of commissions paid to insurance broker | USD $4,914 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $70,199 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,914 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9864919 |
Policy instance | 1 |
Insurance contract or identification number | 9864919 | Number of Individuals Covered | 232 | Total amount of commissions paid to insurance broker | USD $1,626 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,626 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5051150000 |
Policy instance | 1 |
Insurance contract or identification number | 5051150000 | Number of Individuals Covered | 203 | Total amount of commissions paid to insurance broker | USD $29,071 | Total amount of fees paid to insurance company | USD $10,390 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $726,770 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,071 | Amount paid for insurance broker fees | 10390 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12249479 |
Policy instance | 3 |
Insurance contract or identification number | 12249479 | Number of Individuals Covered | 178 | Total amount of commissions paid to insurance broker | USD $1,140 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,485 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,140 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 179 | Total amount of commissions paid to insurance broker | USD $5,791 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $69,960 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,791 | Insurance broker organization code? | 3 | Insurance broker name | BUKATY COMPANIES |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 2 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 188 | Total amount of commissions paid to insurance broker | USD $5,674 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $71,517 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5051150000 |
Policy instance | 1 |
Insurance contract or identification number | 5051150000 | Number of Individuals Covered | 213 | Total amount of commissions paid to insurance broker | USD $33,822 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $845,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12249479 |
Policy instance | 3 |
Insurance contract or identification number | 12249479 | Number of Individuals Covered | 190 | Total amount of commissions paid to insurance broker | USD $1,161 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0707145 |
Policy instance | 3 |
Insurance contract or identification number | 0707145 | Number of Individuals Covered | 213 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $28,689 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $764,987 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12249479 |
Policy instance | 2 |
Insurance contract or identification number | 12249479 | Number of Individuals Covered | 189 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $1,184 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,514 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 ) |
Policy contract number | 51359-000-00001 |
Policy instance | 1 |
Insurance contract or identification number | 51359-000-00001 | Number of Individuals Covered | 185 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $5,288 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $66,364 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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