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DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameDOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN
Plan identification number 501

DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

DOLCE INTERNATIONAL HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:DOLCE INTERNATIONAL HOLDINGS, INC.
Employer identification number (EIN):510369603
NAIC Classification:721110
NAIC Description:Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2014-10-13
5012012-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2013-10-14
5012011-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2012-10-15
5012010-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2011-10-14
5012009-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2011-05-03
5012008-01-01STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE2010-11-29

Plan Statistics for DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN

401k plan membership statisitcs for DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN

Measure Date Value
2016: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,232
Total of all active and inactive participants2016-01-010
Total participants2016-01-010
2015: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01697
Total number of active participants reported on line 7a of the Form 55002015-01-011,232
Total of all active and inactive participants2015-01-011,232
Total participants2015-01-011,232
2014: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,759
Total number of active participants reported on line 7a of the Form 55002014-01-01761
Number of retired or separated participants receiving benefits2014-01-015
Total of all active and inactive participants2014-01-01766
Total participants2014-01-01766
2013: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,448
Total number of active participants reported on line 7a of the Form 55002013-01-01721
Number of retired or separated participants receiving benefits2013-01-0114
Total of all active and inactive participants2013-01-01735
Total participants2013-01-01735
2012: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01864
Total number of active participants reported on line 7a of the Form 55002012-01-01799
Number of retired or separated participants receiving benefits2012-01-0112
Total of all active and inactive participants2012-01-01811
Total participants2012-01-01811
2011: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-012,300
Total number of active participants reported on line 7a of the Form 55002011-01-011,898
Number of retired or separated participants receiving benefits2011-01-017
Total of all active and inactive participants2011-01-011,905
Total participants2011-01-011,905
2010: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,217
Total number of active participants reported on line 7a of the Form 55002010-01-011,230
Number of retired or separated participants receiving benefits2010-01-0140
Total of all active and inactive participants2010-01-011,270
Total participants2010-01-011,270
2009: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,250
Total number of active participants reported on line 7a of the Form 55002009-01-011,336
Number of retired or separated participants receiving benefits2009-01-0123
Total of all active and inactive participants2009-01-011,359
2008: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-011,152
Total number of active participants reported on line 7a of the Form 55002008-01-011,146
Number of retired or separated participants receiving benefits2008-01-0118
Total of all active and inactive participants2008-01-011,164

Financial Data on DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN

Measure Date Value
2012 : DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2012 401k financial data
Total transfer of assets to this plan2012-12-31$754,468
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$754,468
Total income from all sources (including contributions)2012-12-31$11,902
Total of all expenses incurred2012-12-31$245,359
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$242,709
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$11,900
Value of total assets at beginning of year2012-12-31$233,457
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$2,650
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$2,650
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$11,900
Other income not declared elsewhere2012-12-31$2
Total non interest bearing cash at beginning of year2012-12-31$206,008
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-233,457
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$-521,011
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$15,549
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$15,549
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Employer contributions (assets) at beginning of year2012-12-31$11,900
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$242,709
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$754,468
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31BKD, LLP
Accountancy firm EIN2012-12-31440160260
2011 : DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL 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$754,468
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$769,249
Total income from all sources (including contributions)2011-12-31$6,343,812
Total of all expenses incurred2011-12-31$8,577,645
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$7,909,434
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$6,224,846
Value of total assets at end of year2011-12-31$233,457
Value of total assets at beginning of year2011-12-31$2,482,071
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$668,211
Total interest from all sources2011-12-31$65
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$18,999
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$2,218,965
Assets. Other investments not covered elsewhere at end of year2011-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$183,881
Other income not declared elsewhere2011-12-31$118,901
Liabilities. Value of operating payables at beginning of year2011-12-31$9,717
Total non interest bearing cash at end of year2011-12-31$206,008
Total non interest bearing cash at beginning of year2011-12-31$160,555
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-2,233,833
Value of net assets at end of year (total assets less liabilities)2011-12-31$-521,011
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$1,712,822
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$15,549
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,564,883
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,564,883
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$65
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$450,176
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$4,005,881
Employer contributions (assets) at end of year2011-12-31$11,900
Employer contributions (assets) at beginning of year2011-12-31$572,752
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$7,459,258
Contract administrator fees2011-12-31$649,212
Liabilities. Value of benefit claims payable at end of year2011-12-31$754,468
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$759,532
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31BKD, LLP
Accountancy firm EIN2011-12-31440160260
2010 : DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL 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$769,249
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$587,295
Total income from all sources (including contributions)2010-12-31$8,491,924
Total of all expenses incurred2010-12-31$9,346,666
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$8,522,842
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$8,375,686
Value of total assets at end of year2010-12-31$2,482,071
Value of total assets at beginning of year2010-12-31$3,154,859
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$823,824
Total interest from all sources2010-12-31$764
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$24,385
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$2,484,315
Assets. Other investments not covered elsewhere at end of year2010-12-31$183,881
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$74,703
Other income not declared elsewhere2010-12-31$115,474
Administrative expenses (other) incurred2010-12-31$9,104
Liabilities. Value of operating payables at end of year2010-12-31$9,717
Total non interest bearing cash at end of year2010-12-31$160,555
Total non interest bearing cash at beginning of year2010-12-31$36,213
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-854,742
Value of net assets at end of year (total assets less liabilities)2010-12-31$1,712,822
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,567,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,564,883
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$2,216,867
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$2,216,867
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$764
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$542,768
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$5,891,371
Employer contributions (assets) at end of year2010-12-31$572,752
Employer contributions (assets) at beginning of year2010-12-31$827,076
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$7,980,074
Contract administrator fees2010-12-31$790,335
Liabilities. Value of benefit claims payable at end of year2010-12-31$759,532
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$587,295
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31BKD, LLP
Accountancy firm EIN2010-12-31440160260

Form 5500 Responses for DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN

2016: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: DOLCE INTERNATIONAL HOLDINGS, INC. MEDICAL BENEFIT PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedYes
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 )
Policy contract number3217168
Policy instance 4
Insurance contract or identification number3217168
Number of Individuals Covered50
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $6,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA DENTAL HEALTH OF KENTUCKY, INC. (National Association of Insurance Commissioners NAIC id number: 52108 )
Policy contract number3217168
Policy instance 3
Insurance contract or identification number3217168
Number of Individuals Covered18
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $2,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA DENTAL HEALTH OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11167 )
Policy contract number3217168
Policy instance 2
Insurance contract or identification number3217168
Number of Individuals Covered40
Insurance policy start date2015-01-02
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $5,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: )
Policy contract number3217168
Policy instance 1
Insurance contract or identification number3217168
Number of Individuals Covered21
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $2,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTHCARE OF CONNECTICUT, INC. (National Association of Insurance Commissioners NAIC id number: 95660 )
Policy contract number3217168
Policy instance 5
Insurance contract or identification number3217168
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTHCARE OF CONNECTICUT, INC. (National Association of Insurance Commissioners NAIC id number: 95660 )
Policy contract number3217168
Policy instance 6
Insurance contract or identification number3217168
Number of Individuals Covered11
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $177
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $3,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $177
Insurance broker organization code?3
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 )
Policy contract number3217168
Policy instance 5
Insurance contract or identification number3217168
Number of Individuals Covered52
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $814
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $15,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $814
Insurance broker organization code?3
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF VIRGINIA, INC. (National Association of Insurance Commissioners NAIC id number: 52617 )
Policy contract number3217168
Policy instance 4
Insurance contract or identification number3217168
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $31
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31
Insurance broker organization code?3
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11167 )
Policy contract number3217168
Policy instance 2
Insurance contract or identification number3217168
Number of Individuals Covered43
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $669
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $13,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $669
Insurance broker organization code?3
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: )
Policy contract number3217168
Policy instance 1
Insurance contract or identification number3217168
Number of Individuals Covered26
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $405
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $7,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 48119 )
Policy contract number3217168
Policy instance 3
Insurance contract or identification number3217168
Number of Individuals Covered44
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $699
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $13,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $699
Insurance broker organization code?3
Insurance broker nameLOCTON COMPANIES LLC
CIGNA HEALTHCARE OF CONNECTICUT, INC. (National Association of Insurance Commissioners NAIC id number: 95660 )
Policy contract number3217168
Policy instance 7
Insurance contract or identification number3217168
Number of Individuals Covered6
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $99
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $2,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $99
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 )
Policy contract number3217168
Policy instance 6
Insurance contract or identification number3217168
Number of Individuals Covered41
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $657
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $12,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $657
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 )
Policy contract number3217168
Policy instance 5
Insurance contract or identification number3217168
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $46
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46
Insurance broker nameLOCTON COMPANIES LLC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 48119 )
Policy contract number3217168
Policy instance 4
Insurance contract or identification number3217168
Number of Individuals Covered44
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $698
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $13,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $698
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47041 )
Policy contract number3217168
Policy instance 3
Insurance contract or identification number3217168
Number of Individuals Covered15
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $245
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $4,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $245
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11167 )
Policy contract number3217168
Policy instance 2
Insurance contract or identification number3217168
Number of Individuals Covered47
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $752
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $14,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $752
Insurance broker nameLOCTON COMPANIES LLC
CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: )
Policy contract number3217168
Policy instance 1
Insurance contract or identification number3217168
Number of Individuals Covered17
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $275
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $5,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $275
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3217168
Policy instance 1
Insurance contract or identification number3217168
Number of Individuals Covered1546
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,853
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $498,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,853
Insurance broker organization code?3
Insurance broker nameLOCKTON COMPANIES LLC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3217168
Policy instance 1
Insurance contract or identification number3217168
Number of Individuals Covered1898
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,071
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $530,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715825
Policy instance 1
Insurance contract or identification number715825
Number of Individuals Covered1230
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $546,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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