401k Plan data: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN plan

GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 401k Plan overview

Plan Name	GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN
Plan identification number	501

GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

GENOVA DIAGNOSTICS has sponsored the creation of one or more 401k plans.

Company Name: GENOVA DIAGNOSTICS

Employer identification number (EIN): 561565047

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Additional information about GENOVA DIAGNOSTICS

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3657597

More information about GENOVA DIAGNOSTICS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 TERESA MCKENZIE 2023-10-13
501 2021-01-01 TERESA MCKENZIE 2022-10-13
501 2020-01-01 TERESA MCKENZIE 2021-10-11 EARLENE CLARK 2021-10-11
501 2019-01-01 CHRISTINA QUETEL 2020-07-30 EARLENE CLARK 2020-07-29
501 2018-01-01 CHRISTINA QUETEL 2019-07-29 EARLENE CLARK 2019-07-29
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 ANNE DICKENS
501 2011-01-01 EARLENE CLARK
501 2010-01-01 EARLENE CLARK
501 2009-01-01 EARLENE CLARK 2010-07-27
501 2009-01-01 EARLENE CLARK 2010-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	TERESA MCKENZIE	2023-10-13
501	2021-01-01	TERESA MCKENZIE	2022-10-13
501	2020-01-01	TERESA MCKENZIE	2021-10-11	EARLENE CLARK	2021-10-11
501	2019-01-01	CHRISTINA QUETEL	2020-07-30	EARLENE CLARK	2020-07-29
501	2018-01-01	CHRISTINA QUETEL	2019-07-29	EARLENE CLARK	2019-07-29
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	ANNE DICKENS
501	2011-01-01	EARLENE CLARK
501	2010-01-01	EARLENE CLARK
501	2009-01-01			EARLENE CLARK	2010-07-27
501	2009-01-01			EARLENE CLARK	2010-07-27

Plan Statistics for GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN

401k plan membership statisitcs for GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN

Measure Date Value
2022: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 419
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 304
Number of retired or separated participants receiving benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 304
2021: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 292
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 417
Number of retired or separated participants receiving benefits 2021-01-01 2
Total of all active and inactive participants 2021-01-01 419
2020: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 346
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 283
Number of retired or separated participants receiving benefits 2020-01-01 9
Total of all active and inactive participants 2020-01-01 292
2019: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 418
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 339
Number of retired or separated participants receiving benefits 2019-01-01 7
Total of all active and inactive participants 2019-01-01 346
2018: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 443
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 406
Number of retired or separated participants receiving benefits 2018-01-01 12
Total of all active and inactive participants 2018-01-01 418
2017: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 467
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 428
Number of retired or separated participants receiving benefits 2017-01-01 15
Total of all active and inactive participants 2017-01-01 443
2016: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 458
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 464
Number of retired or separated participants receiving benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 467
2015: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 375
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 452
Number of retired or separated participants receiving benefits 2015-01-01 6
Total of all active and inactive participants 2015-01-01 458
2014: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 416
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 368
Number of retired or separated participants receiving benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 375
2013: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 410
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 416
2012: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 205
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 248
Total of all active and inactive participants 2012-01-01 248
Total participants 2012-01-01 248
2011: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 205
Total of all active and inactive participants 2011-01-01 205
Total participants 2011-01-01 205
2010: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 181
Total of all active and inactive participants 2010-01-01 181
Total participants 2010-01-01 181
2009: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 170
Number of retired or separated participants receiving benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 173
Total participants 2009-01-01 173

Measure	Date	Value
2022: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	419
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	304
Number of retired or separated participants receiving benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	304
2021: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	292
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	417
Number of retired or separated participants receiving benefits	2021-01-01	2
Total of all active and inactive participants	2021-01-01	419
2020: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	283
Number of retired or separated participants receiving benefits	2020-01-01	9
Total of all active and inactive participants	2020-01-01	292
2019: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	418
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	339
Number of retired or separated participants receiving benefits	2019-01-01	7
Total of all active and inactive participants	2019-01-01	346
2018: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	443
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	406
Number of retired or separated participants receiving benefits	2018-01-01	12
Total of all active and inactive participants	2018-01-01	418
2017: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	467
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	428
Number of retired or separated participants receiving benefits	2017-01-01	15
Total of all active and inactive participants	2017-01-01	443
2016: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	458
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	464
Number of retired or separated participants receiving benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	467
2015: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	375
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	452
Number of retired or separated participants receiving benefits	2015-01-01	6
Total of all active and inactive participants	2015-01-01	458
2014: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	416
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	368
Number of retired or separated participants receiving benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	375
2013: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	410
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	416
2012: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	205
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	248
Total of all active and inactive participants	2012-01-01	248
Total participants	2012-01-01	248
2011: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	205
Total of all active and inactive participants	2011-01-01	205
Total participants	2011-01-01	205
2010: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	181
Total of all active and inactive participants	2010-01-01	181
Total participants	2010-01-01	181
2009: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	170
Number of retired or separated participants receiving benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	173
Total participants	2009-01-01	173

Form 5500 Responses for GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN

2022: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GENOVA DIAGNOSTICS, INC. CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
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 funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	379
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD068297

Policy instance

Insurance contract or identification number	NYD068297
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $10
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	10
Insurance broker organization code?	3

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

TPO35012

Policy instance

Insurance contract or identification number	TPO35012
Number of Individuals Covered	346
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,481
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 number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	373
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,221
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1221
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	282
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,692
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1692
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	284
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $663
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	663
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	282
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $75
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	75
Insurance broker organization code?	3

EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

7774

Policy instance

Insurance contract or identification number	7774
Number of Individuals Covered	362
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

16861

Policy instance

Insurance contract or identification number	16861
Number of Individuals Covered	37
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,508
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,725
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ 960709

Policy instance

Insurance contract or identification number	SDJ 960709
Number of Individuals Covered	2
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $11
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

EXRK

Policy instance

Insurance contract or identification number	EXRK
Number of Individuals Covered	416
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $20,656
Total amount of fees paid to insurance company	USD $2,546
Welfare Benefit Premiums Paid to Carrier	USD $509,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,656
Additional information about fees paid to insurance broker	SUPP COMPENSATION
Insurance broker organization code?	3
Amount paid for insurance broker fees	2546

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	308
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $748
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	748
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	401
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $581
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	581
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

942876

Policy instance

Insurance contract or identification number	942876
Number of Individuals Covered	255
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $24,417
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $608,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,313
Insurance broker organization code?	3

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	425
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
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 number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	308
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $294
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	294
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	308
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

7774

Policy instance

Insurance contract or identification number	7774
Number of Individuals Covered	344
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

16861

Policy instance

Insurance contract or identification number	16861
Number of Individuals Covered	56
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,522
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $496
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

17883

Policy instance

Insurance contract or identification number	17883
Number of Individuals Covered	12
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $705
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $392
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ 960709

Policy instance

Insurance contract or identification number	SDJ 960709
Number of Individuals Covered	4
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD068297

Policy instance

Insurance contract or identification number	NYD068297
Number of Individuals Covered	1
Insurance policy start date	2021-07-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $15
Total amount of fees paid to insurance company	USD $2
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15
Amount paid for insurance broker fees	2
Insurance broker organization code?	3

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

TPO35012

Policy instance

Insurance contract or identification number	TPO35012
Number of Individuals Covered	372
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,141
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 number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	218
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,412
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2412
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	391
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,188
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2188
Insurance broker organization code?	3

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

TPO35012

Policy instance

Insurance contract or identification number	TPO35012
Number of Individuals Covered	363
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-202480

Policy instance

Insurance contract or identification number	UNI-202480
Number of Individuals Covered	244
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $34,572
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $691,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,743
Insurance broker organization code?	3

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	426
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
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 number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	218
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,095
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1095
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	218
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $123
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	123
Insurance broker organization code?	3

EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

7774

Policy instance

Insurance contract or identification number	7774
Number of Individuals Covered	321
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

16861

Policy instance

Insurance contract or identification number	16861
Number of Individuals Covered	61
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,372
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,322
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

17883

Policy instance

Insurance contract or identification number	17883
Number of Individuals Covered	13
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,909
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,526
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ 960709

Policy instance

Insurance contract or identification number	SDJ 960709
Number of Individuals Covered	2
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD068297

Policy instance

Insurance contract or identification number	NYD068297
Number of Individuals Covered	2
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $34
Total amount of fees paid to insurance company	USD $20
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	339
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,345
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 number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	339
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,267
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 number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	339
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

7774

Policy instance

Insurance contract or identification number	7774
Number of Individuals Covered	415
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $5,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

16861

Policy instance

Insurance contract or identification number	16861
Number of Individuals Covered	84
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $15,365
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,393
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

17883

Policy instance

Insurance contract or identification number	17883
Number of Individuals Covered	31
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,786
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,424
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ 960709

Policy instance

Insurance contract or identification number	SDJ 960709
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $376
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 number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	450
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

TP035012

Policy instance

Insurance contract or identification number	TP035012
Number of Individuals Covered	469
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-202480

Policy instance

Insurance contract or identification number	UNI-202480
Number of Individuals Covered	330
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $29,931
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $598,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,959
Insurance broker organization code?	3

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	575
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	700
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-202480

Policy instance

Insurance contract or identification number	UNI-202480
Number of Individuals Covered	406
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,262
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $481,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,526
Insurance broker organization code?	3
Insurance broker name	C2-COLLABORATION CENTRIC SOLUTIONS

COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

TP035012

Policy instance

Insurance contract or identification number	TP035012
Number of Individuals Covered	564
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,164
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 number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	566
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,730
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 number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	428
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,172
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 number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	428
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,870
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 number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	428
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

7774

Policy instance

Insurance contract or identification number	7774
Number of Individuals Covered	499
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $8,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

16861

Policy instance

Insurance contract or identification number	16861
Number of Individuals Covered	48
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,143
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,343
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

17883

Policy instance

Insurance contract or identification number	17883
Number of Individuals Covered	24
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,651
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,029
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967982

Policy instance

Insurance contract or identification number	OK 967982
Number of Individuals Covered	441
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,194
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 number

LK 964419

Policy instance

Insurance contract or identification number	LK 964419
Number of Individuals Covered	441
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,059
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 number

LK 751727

Policy instance

Insurance contract or identification number	LK 751727
Number of Individuals Covered	441
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220991

Policy instance

Insurance contract or identification number	220991
Number of Individuals Covered	383
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,244
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $431,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,933
Insurance broker organization code?	3
Insurance broker name	C2 CENTRIC LLC

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	662
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $920
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $920
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966453

Policy instance

Insurance contract or identification number	FLX966453
Number of Individuals Covered	452
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,018
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: 71870 )

Policy contract number

9837279

Policy instance

Insurance contract or identification number	9837279
Number of Individuals Covered	501
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $207
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $207
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	592
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,723
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,723
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-4046-00

Policy instance

Insurance contract or identification number	454-4046-00
Number of Individuals Covered	424
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,869
Total amount of fees paid to insurance company	USD $3,226
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL. LIFE, VOL. DEPENDENT LIFE,AD&D
Welfare Benefit Premiums Paid to Carrier	USD $266,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,869
Amount paid for insurance broker fees	3226
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220991

Policy instance

Insurance contract or identification number	220991
Number of Individuals Covered	375
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $52,761
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $452,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,761
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9837279

Policy instance

Insurance contract or identification number	9837279
Number of Individuals Covered	464
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,324
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,324
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

522

Policy instance

Insurance contract or identification number	522
Number of Individuals Covered	549
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,432
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,432
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-4046-00

Policy instance

Insurance contract or identification number	454-4046-00
Number of Individuals Covered	410
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,622
Total amount of fees paid to insurance company	USD $3,226
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D,VOL. LIFE, VOL. DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $239,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,622
Amount paid for insurance broker fees	3226
Additional information about fees paid to insurance broker	BONUS PAID TO PRODUCER
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05774867

Policy instance

Insurance contract or identification number	TM05774867
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $590
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $590
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

04LL

Policy instance

Insurance contract or identification number	04LL
Number of Individuals Covered	121
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $14,931
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $385,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	14931
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9837279

Policy instance

Insurance contract or identification number	9837279
Number of Individuals Covered	108
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $510
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $510
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220991

Policy instance

Insurance contract or identification number	220991
Number of Individuals Covered	234
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $34,430
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $312,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,430
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

0000522

Policy instance

Insurance contract or identification number	0000522
Number of Individuals Covered	364
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,254
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,254
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-4046-00

Policy instance

Insurance contract or identification number	454-4046-00
Number of Individuals Covered	245
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,335
Total amount of fees paid to insurance company	USD $1,945
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL. LIFE, VOL. DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $145,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,335
Amount paid for insurance broker fees	1945
Additional information about fees paid to insurance broker	BONUS PAID TO PRODUCER
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

220991

Policy instance

Insurance contract or identification number	220991
Number of Individuals Covered	211
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $32,872
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $276,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,872
Insurance broker organization code?	3
Insurance broker name	JAMES A. SCOTT & SON, INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-4046-00

Policy instance

Insurance contract or identification number	454-4046-00
Number of Individuals Covered	229
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,545
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $133,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

000522

Policy instance

Insurance contract or identification number	000522
Number of Individuals Covered	205
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,512
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

845

Policy instance

Insurance contract or identification number	845
Number of Individuals Covered	205
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $58,994
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

18023

Policy instance

Insurance contract or identification number	18023
Number of Individuals Covered	205
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,327

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

845

Policy instance

Insurance contract or identification number	845
Number of Individuals Covered	60
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	FLEXIBLE SPENDING, MEDICAL; FLEXIBLE SPENDING, DEPENDENT CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

UP-914K

Policy instance

Insurance contract or identification number	UP-914K
Number of Individuals Covered	186
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $31,967
Total amount of fees paid to insurance company	USD $10,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FLORES AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

1003861886

Policy instance

Insurance contract or identification number	1003861886
Number of Individuals Covered	60
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	FLEXIBLE SPENDING ACCOUNT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54658 )

Policy contract number

000522

Policy instance

Insurance contract or identification number	000522
Number of Individuals Covered	198
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,384
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

454-4046-00

Policy instance

Insurance contract or identification number	454-4046-00
Number of Individuals Covered	222
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $15,646
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $110,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

845

Policy instance

Insurance contract or identification number	845
Number of Individuals Covered	194
Insurance policy start date	2010-10-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANAWHA HEALTHCARE SOLUTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 95592 )

Policy contract number

L40120

Policy instance

Insurance contract or identification number	L40120
Number of Individuals Covered	186
Insurance policy start date	2010-01-01
Insurance policy end date	2010-09-30
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	GENOVA DIAGNOSTICS
Employer identification number (EIN):	561565047
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3657597