BUILDERS SUPPLY GROUP INSURANCE TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST
401k plan membership statisitcs for BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST
| Measure | Date | Value |
|---|
| 2022: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 20 |
| Total of all active and inactive participants | 2022-01-01 | 20 |
| Total participants | 2022-01-01 | 20 |
| Number of employers contributing to the scheme | 2022-01-01 | 10 |
| 2021: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 25 |
| Total of all active and inactive participants | 2021-01-01 | 25 |
| Total participants | 2021-01-01 | 25 |
| Number of employers contributing to the scheme | 2021-01-01 | 11 |
| 2020: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 76 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 41 |
| Total of all active and inactive participants | 2020-01-01 | 41 |
| Total participants | 2020-01-01 | 41 |
| Number of employers contributing to the scheme | 2020-01-01 | 13 |
| 2019: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 60 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 76 |
| Total of all active and inactive participants | 2019-01-01 | 76 |
| Total participants | 2019-01-01 | 76 |
| Number of employers contributing to the scheme | 2019-01-01 | 14 |
| 2018: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 60 |
| Total of all active and inactive participants | 2018-01-01 | 60 |
| Total participants | 2018-01-01 | 60 |
| Number of employers contributing to the scheme | 2018-01-01 | 9 |
| 2017: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 64 |
| Total of all active and inactive participants | 2017-01-01 | 64 |
| Total participants | 2017-01-01 | 64 |
| Number of employers contributing to the scheme | 2017-01-01 | 13 |
| 2016: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 72 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 59 |
| Total of all active and inactive participants | 2016-01-01 | 59 |
| Total participants | 2016-01-01 | 59 |
| Number of employers contributing to the scheme | 2016-01-01 | 15 |
| 2015: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 72 |
| Total of all active and inactive participants | 2015-01-01 | 72 |
| Total participants | 2015-01-01 | 72 |
| Number of employers contributing to the scheme | 2015-01-01 | 12 |
| 2014: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 78 |
| Total of all active and inactive participants | 2014-01-01 | 78 |
| Total participants | 2014-01-01 | 78 |
| Number of employers contributing to the scheme | 2014-01-01 | 16 |
| 2013: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 136 |
| Total of all active and inactive participants | 2013-01-01 | 136 |
| Total participants | 2013-01-01 | 136 |
| Number of employers contributing to the scheme | 2013-01-01 | 22 |
| 2012: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 151 |
| Total of all active and inactive participants | 2012-01-01 | 151 |
| Total participants | 2012-01-01 | 151 |
| Number of employers contributing to the scheme | 2012-01-01 | 22 |
| 2011: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 129 |
| Total of all active and inactive participants | 2011-01-01 | 129 |
| Total participants | 2011-01-01 | 129 |
| Number of employers contributing to the scheme | 2011-01-01 | 31 |
| 2009: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 142 |
| Total of all active and inactive participants | 2009-01-01 | 142 |
| Total participants | 2009-01-01 | 142 |
| Measure | Date | Value |
|---|
| 2022 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $63 |
| Total plan liabilities at beginning of year | 2022-12-31 | $63 |
| Total income from all sources | 2022-12-31 | $10,021 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $10,296 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $10,296 |
| Total plan assets at end of year | 2022-12-31 | $1,256 |
| Total plan assets at beginning of year | 2022-12-31 | $1,531 |
| Total contributions received or receivable from participants | 2022-12-31 | $10,021 |
| Net income (gross income less expenses) | 2022-12-31 | $-275 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $1,193 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,468 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $0 |
| 2021 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $63 |
| Total plan liabilities at beginning of year | 2021-12-31 | $63 |
| Total income from all sources | 2021-12-31 | $19,830 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $22,290 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $21,490 |
| Total plan assets at end of year | 2021-12-31 | $1,531 |
| Total plan assets at beginning of year | 2021-12-31 | $3,991 |
| Total contributions received or receivable from participants | 2021-12-31 | $19,830 |
| Net income (gross income less expenses) | 2021-12-31 | $-2,460 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $1,468 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $3,928 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $800 |
| 2020 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $63 |
| Total plan liabilities at beginning of year | 2020-12-31 | $63 |
| Total income from all sources | 2020-12-31 | $37,008 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $39,099 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $36,132 |
| Total plan assets at end of year | 2020-12-31 | $3,991 |
| Total plan assets at beginning of year | 2020-12-31 | $6,082 |
| Total contributions received or receivable from participants | 2020-12-31 | $37,008 |
| Net income (gross income less expenses) | 2020-12-31 | $-2,091 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $3,928 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $6,019 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $2,967 |
| 2019 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $63 |
| Total plan liabilities at beginning of year | 2019-12-31 | $63 |
| Total income from all sources | 2019-12-31 | $42,740 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $41,385 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $39,885 |
| Total plan assets at end of year | 2019-12-31 | $6,082 |
| Total plan assets at beginning of year | 2019-12-31 | $4,727 |
| Total contributions received or receivable from participants | 2019-12-31 | $42,740 |
| Net income (gross income less expenses) | 2019-12-31 | $1,355 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $6,019 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $4,664 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $1,500 |
| 2018 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $63 |
| Total plan liabilities at beginning of year | 2018-12-31 | $63 |
| Total income from all sources | 2018-12-31 | $42,002 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $41,763 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $39,263 |
| Total plan assets at end of year | 2018-12-31 | $4,727 |
| Total plan assets at beginning of year | 2018-12-31 | $4,488 |
| Total contributions received or receivable from participants | 2018-12-31 | $42,002 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $1,000 |
| Net income (gross income less expenses) | 2018-12-31 | $239 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $4,664 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $4,425 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $1,500 |
| 2017 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $63 |
| Total plan liabilities at beginning of year | 2017-12-31 | $63 |
| Total income from all sources | 2017-12-31 | $39,400 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $39,927 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $35,764 |
| Total plan assets at end of year | 2017-12-31 | $4,488 |
| Total plan assets at beginning of year | 2017-12-31 | $5,015 |
| Total contributions received or receivable from participants | 2017-12-31 | $39,400 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $1,000 |
| Net income (gross income less expenses) | 2017-12-31 | $-527 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $4,425 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $4,952 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $3,163 |
| 2016 : BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $63 |
| Total plan liabilities at beginning of year | 2016-12-31 | $0 |
| Total income from all sources | 2016-12-31 | $41,312 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $41,275 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $36,129 |
| Total plan assets at end of year | 2016-12-31 | $5,015 |
| Total plan assets at beginning of year | 2016-12-31 | $4,915 |
| Total contributions received or receivable from participants | 2016-12-31 | $41,312 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $900 |
| Net income (gross income less expenses) | 2016-12-31 | $37 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $4,952 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $4,915 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $4,246 |
| 2022: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Multi-employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Multi-employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Multi-employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Multi-employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Multi-employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Multi-employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Multi-employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Multi-employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Multi-employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BUILDERS SUPPLY ASSOCIATION GROUP INSURANCE TRUST 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Mulitple employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18278 |
| Policy instance | 2 |
| Insurance contract or identification number | 18278 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $458 |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $392 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,848 | | Commission paid to Insurance Broker | USD $392 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18278 |
| Policy instance | 2 |
| Insurance contract or identification number | 18278 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $416 |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $924 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,480 | | Commission paid to Insurance Broker | USD $924 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18278 |
| Policy instance | 2 |
| Insurance contract or identification number | 18278 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,805 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $33,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,805 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,847 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $36,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,847 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18278 |
| Policy instance | 2 |
| Insurance contract or identification number | 18278 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,815 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $36,291 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,815 | | Insurance broker organization code? | 3 |
|
| FORREST T. JONES AND COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 71878 ) |
| Policy contract number | 12233-18278 |
| Policy instance | 2 |
| Insurance contract or identification number | 12233-18278 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of fees paid to insurance company | USD $111 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 111 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 2 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,623 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $32,461 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $669 | | Insurance broker organization code? | 3 | | Insurance broker name | DIGITAL INSURANCE |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 12233-18278 |
| Policy instance | 1 |
| Insurance contract or identification number | 12233-18278 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $184 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 08005 |
| Policy instance | 2 |
| Insurance contract or identification number | 08005 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $105 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 105 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEE | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE, INC. |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $792 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $37,548 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $792 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEE | | Insurance broker organization code? | 3 | | Insurance broker name | HUNTINGTON INSURANCE INC. |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 2 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,640 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $52,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,640 | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS SERVICES OF WV INC |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 08005 |
| Policy instance | 1 |
| Insurance contract or identification number | 08005 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $153 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 153 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEE | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INS OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | GROUP 08005 |
| Policy instance | 2 |
| Insurance contract or identification number | GROUP 08005 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $223 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 213 | | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | | Insurance broker name | WELLS FARGO INS OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | GROUP 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | GROUP 01029 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,466 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $69,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,466 | | Insurance broker name | WELLS FARGO INS SERVICES OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 41 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $213 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 213 | | Additional information about fees paid to insurance broker | ADMIN FEES | | Insurance broker name | WELLS FARGO INS OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 259 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,973 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,973 | | Insurance broker name | WELLS FARGO INS SERVICES OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 01029 |
| Policy instance | 1 |
| Insurance contract or identification number | 01029 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,929 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,580 |
|
| DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
| Policy contract number | 08005 |
| Policy instance | 2 |
| Insurance contract or identification number | 08005 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of fees paid to insurance company | USD $99 | | Welfare Benefit Premiums Paid to Carrier | USD $0 |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 1029 |
| Policy instance | 1 |
| Insurance contract or identification number | 1029 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2009-12-31 | | Total amount of commissions paid to insurance broker | USD $3,492 | | Total amount of fees paid to insurance company | USD $21,080 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,845 | | Commission paid to Insurance Broker | USD $3,492 | | Insurance broker name | WELLS FARGO INS SERVICES OF WV INC |
|
| DELTA DENTAL OF DISTRICT OF COLUMBIA (National Association of Insurance Commissioners NAIC id number: 12329 ) |
| Policy contract number | 8005 |
| Policy instance | 2 |
| Insurance contract or identification number | 8005 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of fees paid to insurance company | USD $211 | | Welfare Benefit Premiums Paid to Carrier | USD $65 |
|
