WOODBERRY FOREST SCHOOL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE
401k plan membership statisitcs for WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE
| Measure | Date | Value |
|---|
| 2021: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-08-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 211 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 2 |
| Total of all active and inactive participants | 2021-08-01 | 213 |
| 2020: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-08-01 | 207 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 210 |
| Number of retired or separated participants receiving benefits | 2020-08-01 | 3 |
| Total of all active and inactive participants | 2020-08-01 | 213 |
| 2019: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-08-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 200 |
| Number of retired or separated participants receiving benefits | 2019-08-01 | 3 |
| Total of all active and inactive participants | 2019-08-01 | 203 |
| 2018: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-08-01 | 204 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 202 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 1 |
| Total of all active and inactive participants | 2018-08-01 | 203 |
| 2017: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-08-01 | 211 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 202 |
| Number of retired or separated participants receiving benefits | 2017-08-01 | 2 |
| Total of all active and inactive participants | 2017-08-01 | 204 |
| 2016: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-08-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 209 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 2 |
| Total of all active and inactive participants | 2016-08-01 | 211 |
| 2015: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 202 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 3 |
| Total of all active and inactive participants | 2015-08-01 | 205 |
| 2014: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 203 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 3 |
| Total of all active and inactive participants | 2014-08-01 | 206 |
| 2013: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 191 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 2 |
| Total of all active and inactive participants | 2013-08-01 | 193 |
| 2012: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 192 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 1 |
| Total of all active and inactive participants | 2012-08-01 | 193 |
| 2011: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 187 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 2 |
| Total of all active and inactive participants | 2011-08-01 | 189 |
| 2009: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 186 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 1 |
| Total of all active and inactive participants | 2009-08-01 | 187 |
| 2021: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2021 form 5500 responses |
|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2020 form 5500 responses |
|---|
| 2020-08-01 | Type of plan entity | Single employer plan |
| 2020-08-01 | Submission has been amended | Yes |
| 2020-08-01 | Plan funding arrangement – Insurance | Yes |
| 2020-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2019 form 5500 responses |
|---|
| 2019-08-01 | Type of plan entity | Single employer plan |
| 2019-08-01 | Plan funding arrangement – Insurance | Yes |
| 2019-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2018 form 5500 responses |
|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2017 form 5500 responses |
|---|
| 2017-08-01 | Type of plan entity | Single employer plan |
| 2017-08-01 | Plan funding arrangement – Insurance | Yes |
| 2017-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2016 form 5500 responses |
|---|
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: WOODBERRY FOREST SCHOOL HOSPITALIZATION INSURANCE 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 309330 |
| Policy instance | 2 |
| Insurance contract or identification number | 309330 | | Number of Individuals Covered | 430 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $8,904 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,904 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 925137 |
| Policy instance | 1 |
| Insurance contract or identification number | 925137 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $15,660 | | 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 $2,498,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,660 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 005105 |
| Policy instance | 2 |
| Insurance contract or identification number | 005105 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $10,973 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 005105 |
| Policy instance | 3 |
| Insurance contract or identification number | 005105 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,680,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005675 |
| Policy instance | 4 |
| Insurance contract or identification number | AL00005675 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $106,710 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 38136 |
| Policy instance | 5 |
| Insurance contract or identification number | 38136 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $1,465 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $608 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 005105 |
| Policy instance | 6 |
| Insurance contract or identification number | 005105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 005105 |
| Policy instance | 7 |
| Insurance contract or identification number | 005105 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $482,459 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 38136 |
| Policy instance | 8 |
| Insurance contract or identification number | 38136 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $2,139 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CANCER | | Welfare Benefit Premiums Paid to Carrier | USD $8,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $908 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 38136 |
| Policy instance | 9 |
| Insurance contract or identification number | 38136 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $842 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $2,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $367 |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 005105 |
| Policy instance | 1 |
| Insurance contract or identification number | 005105 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | 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 $89,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005675 |
| Policy instance | 4 |
| Insurance contract or identification number | AL00005675 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 05105 |
| Policy instance | 3 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 314 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,814,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 05105 |
| Policy instance | 2 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $529,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 576970 |
| Policy instance | 1 |
| Insurance contract or identification number | 576970 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | 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 $89,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 05105 |
| Policy instance | 2 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $567,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 576970 |
| Policy instance | 1 |
| Insurance contract or identification number | 576970 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | 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 $79,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 05105 |
| Policy instance | 3 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,871,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005675 |
| Policy instance | 4 |
| Insurance contract or identification number | AL00005675 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005675 |
| Policy instance | 4 |
| Insurance contract or identification number | AL00005675 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
| Policy contract number | 05105 |
| Policy instance | 3 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 390 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,183,126 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 05105 |
| Policy instance | 2 |
| Insurance contract or identification number | 05105 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
| Policy contract number | 576970 |
| Policy instance | 1 |
| Insurance contract or identification number | 576970 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 $71,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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