W. L. GORE & ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.
Additional information about W. L. GORE & ASSOCIATES, INC.
Submission information for form 5500 for 401k plan W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION
401k plan membership statisitcs for W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION
| Measure | Date | Value |
|---|
| 2022: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 8,217 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 8,631 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 244 |
| Total of all active and inactive participants | 2022-01-01 | 8,875 |
| 2021: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 8,056 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 7,989 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 228 |
| Total of all active and inactive participants | 2021-01-01 | 8,217 |
| 2020: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 7,866 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 7,870 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 186 |
| Total of all active and inactive participants | 2020-01-01 | 8,056 |
| 2019: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 6,929 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 7,681 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 185 |
| Total of all active and inactive participants | 2019-01-01 | 7,866 |
| 2018: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 5,726 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 6,010 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 201 |
| Total of all active and inactive participants | 2018-01-01 | 6,211 |
| 2017: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 5,821 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 5,477 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 249 |
| Total of all active and inactive participants | 2017-01-01 | 5,726 |
| 2016: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 5,913 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 5,655 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 166 |
| Total of all active and inactive participants | 2016-01-01 | 5,821 |
| 2015: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 5,849 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 5,773 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 140 |
| Total of all active and inactive participants | 2015-01-01 | 5,913 |
| 2014: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 5,675 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 5,715 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 134 |
| Total of all active and inactive participants | 2014-01-01 | 5,849 |
| 2013: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 5,802 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 5,521 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 154 |
| Total of all active and inactive participants | 2013-01-01 | 5,675 |
| 2012: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 5,339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 5,662 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 140 |
| Total of all active and inactive participants | 2012-01-01 | 5,802 |
| 2011: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 5,147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 5,255 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 84 |
| Total of all active and inactive participants | 2011-01-01 | 5,339 |
| 2010: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 5,227 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 5,066 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 81 |
| Total of all active and inactive participants | 2010-01-01 | 5,147 |
| 2009: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 5,227 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 5,227 |
| Total of all active and inactive participants | 2009-01-01 | 5,227 |
| 2022: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: W.L. GORE & ASSOCIATES, INC. BL CR & BL SH GROUP HOSPITALIZATION 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9065263-A |
| Policy instance | 5 |
| Insurance contract or identification number | GTP 9065263-A | | Number of Individuals Covered | 8631 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,072 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,072 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6043-22 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6043-22 | | Number of Individuals Covered | 8631 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $360 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $360 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 334589 |
| Policy instance | 3 |
| Insurance contract or identification number | 334589 | | Number of Individuals Covered | 8564 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $678,900 | | Total amount of fees paid to insurance company | USD $94,292 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,543,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $678,900 | | Amount paid for insurance broker fees | 94292 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12294080 |
| Policy instance | 2 |
| Insurance contract or identification number | 12294080 | | Number of Individuals Covered | 6379 | | 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 $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 25 | | 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 $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $198,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | 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 $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $274,323 | | 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: 39616 ) |
| Policy contract number | 12294080 |
| Policy instance | 2 |
| Insurance contract or identification number | 12294080 | | Number of Individuals Covered | 6057 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 334589 |
| Policy instance | 3 |
| Insurance contract or identification number | 334589 | | Number of Individuals Covered | 11427 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $600,873 | | Total amount of fees paid to insurance company | USD $83,455 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,276,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $600,873 | | Amount paid for insurance broker fees | 83455 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6043-21 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6043-21 | | Number of Individuals Covered | 7870 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $249 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $249 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9065263-A |
| Policy instance | 5 |
| Insurance contract or identification number | GTP 9065263-A | | Number of Individuals Covered | 7870 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,072 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,072 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9065263-A |
| Policy instance | 5 |
| Insurance contract or identification number | GTP 9065263-A | | Number of Individuals Covered | 7870 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,199 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6043-20 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6043-20 | | Number of Individuals Covered | 7870 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $970 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $970 | | Additional information about fees paid to insurance broker | ACCESS FEES | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 334589 |
| Policy instance | 3 |
| Insurance contract or identification number | 334589 | | Number of Individuals Covered | 11465 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $696,190 | | Total amount of fees paid to insurance company | USD $96,693 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,534,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $696,190 | | Amount paid for insurance broker fees | 96693 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12294080 |
| Policy instance | 2 |
| Insurance contract or identification number | 12294080 | | Number of Individuals Covered | 6009 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $388,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 9065263-A |
| Policy instance | 5 |
| Insurance contract or identification number | GTP 9065263-A | | Number of Individuals Covered | 7681 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,199 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Insurance broker organization code? | 3 |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6043-19 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6043-19 | | Number of Individuals Covered | 7681 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $918 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $918 | | Additional information about fees paid to insurance broker | ACCESS FEES | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 334589 |
| Policy instance | 3 |
| Insurance contract or identification number | 334589 | | Number of Individuals Covered | 11336 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $673,574 | | Total amount of fees paid to insurance company | USD $93,552 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,085,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $673,574 | | Amount paid for insurance broker fees | 93552 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12294080 |
| Policy instance | 2 |
| Insurance contract or identification number | 12294080 | | Number of Individuals Covered | 5678 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $580,703 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $687,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | MERCER HEALTH & BENEFITS LLC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $885,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | MERCER HEALTH & BENEFITS LLC. |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $909,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $18,493 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $726,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,493 | | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066 |
| Policy instance | 1 |
| Insurance contract or identification number | 840066 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $616,954 | | 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 | 600416-0000 |
| Policy instance | 1 |
| Insurance contract or identification number | 600416-0000 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $26,473 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $592,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 840066-ERG |
| Policy instance | 3 |
| Insurance contract or identification number | 840066-ERG | | Number of Individuals Covered | 108 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $172,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 02802A |
| Policy instance | 2 |
| Insurance contract or identification number | 02802A | | Number of Individuals Covered | 108 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EAP, EVACUATION | | Welfare Benefit Premiums Paid to Carrier | USD $297,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 02802A |
| Policy instance | 2 |
| Insurance contract or identification number | 02802A | | Number of Individuals Covered | 31 | | 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 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EAP, EVACUATION | | Welfare Benefit Premiums Paid to Carrier | USD $421,298 | | 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 | 600416-0000 |
| Policy instance | 1 |
| Insurance contract or identification number | 600416-0000 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $26,324 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $740,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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