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PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN
Plan identification number 501

PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

PATIENT FIRST CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:PATIENT FIRST CORPORATION
Employer identification number (EIN):541353272
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Additional information about PATIENT FIRST CORPORATION

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1985-04-29
Company Identification Number: 0270083
Legal Registered Office Address: 5000 COX RD STE 100

GLEN ALLEN
United States of America (USA)
23060

More information about PATIENT FIRST CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01
5012021-04-01
5012020-04-01
5012019-04-01
5012018-04-01
5012017-04-01TOM HALL
5012016-04-01TOM HALL
5012015-04-01DALE E. AUSTIN
5012014-04-01DALE E. AUSTIN
5012013-04-01DALE E. AUSTIN DALE E. AUSTIN2014-10-13
5012012-04-01DALE E. AUSTIN
5012011-04-01DALE E. AUSTIN
5012010-04-01DALE E. AUSTIN
5012009-04-01DALE E. AUSTIN
5012007-04-01DALE AUSTIN
5012006-04-01DALE AUSTIN
5012005-04-01DALE AUSTIN
5012004-04-01DALE AUSTIN
5012003-04-01DALE AUSTIN
5012002-04-01DALE AUSTIN
5012001-04-01DALE AUSTIN

Plan Statistics for PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2022: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-015,129
Total number of active participants reported on line 7a of the Form 55002022-04-014,673
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-014,673
2021: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-014,515
Total number of active participants reported on line 7a of the Form 55002021-04-013,531
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-013,531
2020: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-012,868
Total number of active participants reported on line 7a of the Form 55002020-04-012,944
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-012,944
2019: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-012,748
Total number of active participants reported on line 7a of the Form 55002019-04-012,868
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-012,868
2018: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-012,970
Total number of active participants reported on line 7a of the Form 55002018-04-012,748
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-012,748
2017: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-012,679
Total number of active participants reported on line 7a of the Form 55002017-04-012,970
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-012,970
2016: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-012,961
Total number of active participants reported on line 7a of the Form 55002016-04-012,679
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-012,679
2015: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-012,215
Total number of active participants reported on line 7a of the Form 55002015-04-012,961
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-012,961
2014: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-011,803
Total number of active participants reported on line 7a of the Form 55002014-04-012,215
Number of retired or separated participants receiving benefits2014-04-013
Number of other retired or separated participants entitled to future benefits2014-04-01781
Total of all active and inactive participants2014-04-012,999
2013: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-011,437
Total number of active participants reported on line 7a of the Form 55002013-04-011,803
Number of retired or separated participants receiving benefits2013-04-0141
Number of other retired or separated participants entitled to future benefits2013-04-01495
Total of all active and inactive participants2013-04-012,339
2012: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-011,689
Total number of active participants reported on line 7a of the Form 55002012-04-011,437
Number of retired or separated participants receiving benefits2012-04-0164
Number of other retired or separated participants entitled to future benefits2012-04-01409
Total of all active and inactive participants2012-04-011,910
2011: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-011,524
Total number of active participants reported on line 7a of the Form 55002011-04-011,258
Number of retired or separated participants receiving benefits2011-04-0156
Number of other retired or separated participants entitled to future benefits2011-04-01373
Total of all active and inactive participants2011-04-011,687
2010: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-011,368
Total number of active participants reported on line 7a of the Form 55002010-04-011,524
Total of all active and inactive participants2010-04-011,524
2009: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-011,097
Total number of active participants reported on line 7a of the Form 55002009-04-011,368
Total of all active and inactive participants2009-04-011,368
2007: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-04-01777
Total number of active participants reported on line 7a of the Form 55002007-04-01973
Total of all active and inactive participants2007-04-01973
Total participants2007-04-01973
2006: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-04-01715
Total number of active participants reported on line 7a of the Form 55002006-04-01777
Total of all active and inactive participants2006-04-01777
Total participants2006-04-01777
2005: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-04-01647
Total number of active participants reported on line 7a of the Form 55002005-04-01715
Total of all active and inactive participants2005-04-01715
Total participants2005-04-01715
2004: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year2004-04-01583
Total number of active participants reported on line 7a of the Form 55002004-04-01647
Total of all active and inactive participants2004-04-01647
Total participants2004-04-01647
2003: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year2003-04-01556
Total number of active participants reported on line 7a of the Form 55002003-04-01583
Total of all active and inactive participants2003-04-01583
Total participants2003-04-01583
2002: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year2002-04-01513
Total number of active participants reported on line 7a of the Form 55002002-04-01556
Total of all active and inactive participants2002-04-01556
Total participants2002-04-01556
2001: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2001 401k membership
Total participants, beginning-of-year2001-04-01460
Total number of active participants reported on line 7a of the Form 55002001-04-01513
Total of all active and inactive participants2001-04-01513
Total participants2001-04-01513

Form 5500 Responses for PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN

2022: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedYes
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes
2007: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-04-01Type of plan entitySingle employer plan
2007-04-01Submission has been amendedNo
2007-04-01This submission is the final filingNo
2007-04-01This return/report is a short plan year return/report (less than 12 months)No
2007-04-01Plan is a collectively bargained planNo
2007-04-01Plan funding arrangement – InsuranceYes
2007-04-01Plan benefit arrangement – InsuranceYes
2006: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-04-01Type of plan entitySingle employer plan
2006-04-01Submission has been amendedNo
2006-04-01This submission is the final filingNo
2006-04-01This return/report is a short plan year return/report (less than 12 months)No
2006-04-01Plan is a collectively bargained planNo
2006-04-01Plan funding arrangement – InsuranceYes
2006-04-01Plan benefit arrangement – InsuranceYes
2005: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-04-01Type of plan entitySingle employer plan
2005-04-01Submission has been amendedNo
2005-04-01This submission is the final filingNo
2005-04-01This return/report is a short plan year return/report (less than 12 months)No
2005-04-01Plan is a collectively bargained planNo
2005-04-01Plan funding arrangement – InsuranceYes
2005-04-01Plan benefit arrangement – InsuranceYes
2004: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2004 form 5500 responses
2004-04-01Type of plan entitySingle employer plan
2004-04-01Submission has been amendedNo
2004-04-01This submission is the final filingNo
2004-04-01This return/report is a short plan year return/report (less than 12 months)No
2004-04-01Plan is a collectively bargained planNo
2004-04-01Plan funding arrangement – InsuranceYes
2004-04-01Plan benefit arrangement – InsuranceYes
2003: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2003 form 5500 responses
2003-04-01Type of plan entitySingle employer plan
2003-04-01Submission has been amendedNo
2003-04-01This submission is the final filingNo
2003-04-01This return/report is a short plan year return/report (less than 12 months)No
2003-04-01Plan is a collectively bargained planNo
2003-04-01Plan funding arrangement – InsuranceYes
2003-04-01Plan benefit arrangement – InsuranceYes
2002: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2002 form 5500 responses
2002-04-01Type of plan entityMulti-employer plan
2002-04-01Submission has been amendedNo
2002-04-01This submission is the final filingNo
2002-04-01This return/report is a short plan year return/report (less than 12 months)No
2002-04-01Plan is a collectively bargained planNo
2002-04-01Plan funding arrangement – InsuranceYes
2002-04-01Plan benefit arrangement – InsuranceYes
2001: PATIENT FIRST CORP EMPLOYEE HEALTH & WELFARE BENEFIT PLAN 2001 form 5500 responses
2001-04-01Type of plan entitySingle employer plan
2001-04-01Submission has been amendedNo
2001-04-01This submission is the final filingNo
2001-04-01This return/report is a short plan year return/report (less than 12 months)No
2001-04-01Plan is a collectively bargained planNo
2001-04-01Plan funding arrangement – InsuranceYes
2001-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 11
Insurance contract or identification numberVA3336
Number of Individuals Covered3887
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $49,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered2769
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $20,523
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,523
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98119851001
Policy instance 2
Insurance contract or identification number98119851001
Number of Individuals Covered2877
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $205,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered4673
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $754
Total amount of fees paid to insurance companyUSD $126
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $5,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $754
Amount paid for insurance broker fees126
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 4
Insurance contract or identification number135545
Number of Individuals Covered1625
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $16,765
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,765
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 5
Insurance contract or identification number135545
Number of Individuals Covered1462
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $20,143
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,143
Additional information about fees paid to insurance brokerCONTINGENT COMMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 6
Insurance contract or identification number135545
Number of Individuals Covered921
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $57,415
Total amount of fees paid to insurance companyUSD $4,636
Welfare Benefit Premiums Paid to CarrierUSD $228,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,762
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees4636
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 7
Insurance contract or identification numberVA3336
Number of Individuals Covered1945
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of fees paid to insurance companyUSD $1,098,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1098129
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 8
Insurance contract or identification numberVA3336
Number of Individuals Covered1946
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,288
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 numberVA3336
Policy instance 9
Insurance contract or identification numberVA3336
Number of Individuals Covered748
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of fees paid to insurance companyUSD $372,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees372618
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10299371001
Policy instance 10
Insurance contract or identification number10299371001
Number of Individuals Covered8
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 4
Insurance contract or identification number135545
Number of Individuals Covered1669
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $6,666
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,666
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered3531
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $754
Total amount of fees paid to insurance companyUSD $110
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $5,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $754
Amount paid for insurance broker fees110
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98119851001
Policy instance 2
Insurance contract or identification number98119851001
Number of Individuals Covered2997
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $191,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered2811
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $7,900
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,900
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 5
Insurance contract or identification number135545
Number of Individuals Covered1498
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $7,839
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,839
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 6
Insurance contract or identification number135545
Number of Individuals Covered1330
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $94,834
Welfare Benefit Premiums Paid to CarrierUSD $451,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $90,309
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 7
Insurance contract or identification numberVA3336
Number of Individuals Covered1217
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of fees paid to insurance companyUSD $1,185,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1185021
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 8
Insurance contract or identification numberVA3336
Number of Individuals Covered2001
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,403
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 numberVA3336
Policy instance 9
Insurance contract or identification numberVA3336
Number of Individuals Covered782
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of fees paid to insurance companyUSD $305,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees305270
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10299371001
Policy instance 10
Insurance contract or identification number10299371001
Number of Individuals Covered24
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,572
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 numberVA3336
Policy instance 11
Insurance contract or identification numberVA3336
Number of Individuals Covered2852
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $39,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered2783
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number98119851001
Policy instance 2
Insurance contract or identification number98119851001
Number of Individuals Covered3010
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered2944
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $940
Total amount of fees paid to insurance companyUSD $109
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $940
Amount paid for insurance broker fees109
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 4
Insurance contract or identification number135545
Number of Individuals Covered1772
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 5
Insurance contract or identification number135545
Number of Individuals Covered1572
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 6
Insurance contract or identification number135545
Number of Individuals Covered1261
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $99,585
Welfare Benefit Premiums Paid to CarrierUSD $421,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $84,272
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 7
Insurance contract or identification numberVA3336
Number of Individuals Covered2024
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $943,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees943016
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberVA3336
Policy instance 8
Insurance contract or identification numberVA3336
Number of Individuals Covered2029
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,842
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 numberVA3336
Policy instance 9
Insurance contract or identification numberVA3336
Number of Individuals Covered915
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of fees paid to insurance companyUSD $301,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees301255
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATION
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number98119851001
Policy instance 2
Insurance contract or identification number98119851001
Number of Individuals Covered2862
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $164,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered2868
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $940
Total amount of fees paid to insurance companyUSD $79
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $940
Amount paid for insurance broker fees79
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 4
Insurance contract or identification number135545
Number of Individuals Covered1747
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $30,165
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,165
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 5
Insurance contract or identification number135545
Number of Individuals Covered1545
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $36,087
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,087
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 6
Insurance contract or identification number135545
Number of Individuals Covered940
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $106,636
Welfare Benefit Premiums Paid to CarrierUSD $424,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $84,942
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered2072
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $33,045
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,045
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number408542
Policy instance 4
Insurance contract or identification number408542
Number of Individuals Covered2175
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,099,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered4400
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $989
Total amount of fees paid to insurance companyUSD $87
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $989
Amount paid for insurance broker fees87
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number98119851001
Policy instance 2
Insurance contract or identification number98119851001
Number of Individuals Covered2381
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $150,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered1836
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $7,677
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,677
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberAPL665734
Policy instance 4
Insurance contract or identification numberAPL665734
Number of Individuals Covered4400
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $496
Total amount of fees paid to insurance companyUSD $33
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $3,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $496
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerSALES AND SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9811985
Policy instance 3
Insurance contract or identification number9811985
Number of Individuals Covered1787
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $7,617
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,617
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1033295
Policy instance 2
Insurance contract or identification number1033295
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of fees paid to insurance companyUSD $5,493
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5493
Additional information about fees paid to insurance brokerCOMMISSIONS PAID BONUS FEES PAID
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SERVICES USA INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered1698
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $22,505
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,505
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1033295
Policy instance 2
Insurance contract or identification number1033295
Number of Individuals Covered1150
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,117,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerCOMMISSIONS PAID BONUS FEES PAID
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SERVICES, INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered1436
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $33,499
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,499
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9811985
Policy instance 3
Insurance contract or identification number9811985
Number of Individuals Covered1464
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,737
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,737
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9811985
Policy instance 3
Insurance contract or identification number9811985
Number of Individuals Covered1118
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $4,324
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,324
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD BENEFIT SVCS
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 1
Insurance contract or identification number135545
Number of Individuals Covered1345
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $36,507
Total amount of fees paid to insurance companyUSD $4,118
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,300
Additional information about fees paid to insurance brokerCOMMISSIONS PAID CONTINGENT COMMISSIONS PAID
Insurance broker organization code?3
Amount paid for insurance broker fees4118
Insurance broker nameRUTHERFOORD FIN SVCS INC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1033295
Policy instance 2
Insurance contract or identification number1033295
Number of Individuals Covered1016
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $58,270
Total amount of fees paid to insurance companyUSD $21,114
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,070,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,934
Amount paid for insurance broker fees21114
Additional information about fees paid to insurance brokerCOMMISSIONS PAID BONUS FEES PAID
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SERVICES, INC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 2
Insurance contract or identification number135545
Number of Individuals Covered1184
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $32,219
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,885
Additional information about fees paid to insurance brokerCOMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FIN SVCS INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 3
Insurance contract or identification numberABL665734
Number of Individuals Covered1437
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $55
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000208408
Policy instance 4
Insurance contract or identification number000000208408
Number of Individuals Covered1040
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $32,592
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $393,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,592
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SVCS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000360367
Policy instance 1
Insurance contract or identification number000000360367
Number of Individuals Covered456
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $6,489
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $500,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,502
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SVCS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number000000208408
Policy instance 7
Insurance contract or identification number000000208408
Number of Individuals Covered873
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $29,803
Total amount of fees paid to insurance companyUSD $2,693
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $359,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )
Policy contract number000700013
Policy instance 8
Insurance contract or identification number000700013
Number of Individuals Covered2081
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $55,634
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA BEHAVIORAL HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number1714
Policy instance 9
Insurance contract or identification number1714
Number of Individuals Covered1632
Insurance policy start date2011-01-01
Insurance policy end date2011-05-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $13,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9811985
Policy instance 10
Insurance contract or identification number9811985
Number of Individuals Covered581
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,136
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66850
Policy instance 3
Insurance contract or identification number66850
Number of Individuals Covered829
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 6
Insurance contract or identification numberABL665734
Number of Individuals Covered1166
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $222
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 5
Insurance contract or identification number135545
Number of Individuals Covered1032
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $30,120
Life Insurance Welfare BenefitYes
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 numberODO521
Policy instance 2
Insurance contract or identification numberODO521
Number of Individuals Covered1364
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $674,869
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 number40719
Policy instance 1
Insurance contract or identification number40719
Number of Individuals Covered289
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $94,371
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 number000000360367
Policy instance 4
Insurance contract or identification number000000360367
Number of Individuals Covered417
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $3,582
Total amount of fees paid to insurance companyUSD $1,239
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $325,655
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 number40719
Policy instance 1
Insurance contract or identification number40719
Number of Individuals Covered197
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $52,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA BEHAVIORAL HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number1714
Policy instance 10
Insurance contract or identification number1714
Number of Individuals Covered1524
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )
Policy contract number000700013
Policy instance 9
Insurance contract or identification number000700013
Number of Individuals Covered1833
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Dental Insurance Welfare BenefitYes
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 number000000208408
Policy instance 8
Insurance contract or identification number000000208408
Number of Individuals Covered794
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $26,186
Total amount of fees paid to insurance companyUSD $727
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $317,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,186
Amount paid for insurance broker fees727
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SVCS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL665734
Policy instance 7
Insurance contract or identification numberABL665734
Number of Individuals Covered1166
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $222
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $222
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number135545
Policy instance 6
Insurance contract or identification number135545
Number of Individuals Covered821
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $13,554
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,554
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FIN SVCS INC
SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )
Policy contract number7-36800
Policy instance 4
Insurance contract or identification number7-36800
Number of Individuals Covered90
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,928
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,928
Insurance broker organization code?3
Insurance broker nameTHOMAS RUTHERFOORD, INC.
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number580016-5800117
Policy instance 3
Insurance contract or identification number580016-5800117
Number of Individuals Covered809
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Health Insurance Welfare BenefitYes
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 numberODO521
Policy instance 2
Insurance contract or identification numberODO521
Number of Individuals Covered1207
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Health Insurance Welfare BenefitYes
Other welfare benefits providedSTOP LOSS
Welfare Benefit Premiums Paid to CarrierUSD $423,707
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 number000000360367
Policy instance 5
Insurance contract or identification number000000360367
Number of Individuals Covered318
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $4,167
Total amount of fees paid to insurance companyUSD $714
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $378,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,167
Amount paid for insurance broker fees714
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Insurance broker nameRUTHERFOORD FINANCIAL SVCS

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