SKC, INC. has sponsored the creation of one or more 401k plans.
Additional information about SKC, INC.
Submission information for form 5500 for 401k plan SKC, INC. - HEALTH & WELFARE PLAN
401k plan membership statisitcs for SKC, INC. - HEALTH & WELFARE PLAN
Measure | Date | Value |
---|
2022: SKC, INC. - HEALTH & WELFARE PLAN 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-08-01 | 248 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 218 |
Number of retired or separated participants receiving benefits | 2022-08-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
Total of all active and inactive participants | 2022-08-01 | 220 |
2021: SKC, INC. - HEALTH & WELFARE PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-08-01 | 231 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 245 |
Number of retired or separated participants receiving benefits | 2021-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
Total of all active and inactive participants | 2021-08-01 | 248 |
2020: SKC, INC. - HEALTH & WELFARE PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-08-01 | 228 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-08-01 | 228 |
Number of retired or separated participants receiving benefits | 2020-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2020-08-01 | 0 |
Total of all active and inactive participants | 2020-08-01 | 231 |
2019: SKC, INC. - HEALTH & WELFARE PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-08-01 | 229 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-08-01 | 225 |
Number of retired or separated participants receiving benefits | 2019-08-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2019-08-01 | 0 |
Total of all active and inactive participants | 2019-08-01 | 228 |
2018: SKC, INC. - HEALTH & WELFARE PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-08-01 | 248 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 228 |
Number of retired or separated participants receiving benefits | 2018-08-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
Total of all active and inactive participants | 2018-08-01 | 229 |
2017: SKC, INC. - HEALTH & WELFARE PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-08-01 | 304 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-08-01 | 242 |
Number of retired or separated participants receiving benefits | 2017-08-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2017-08-01 | 0 |
Total of all active and inactive participants | 2017-08-01 | 248 |
2016: SKC, INC. - HEALTH & WELFARE PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-08-01 | 340 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 292 |
Number of retired or separated participants receiving benefits | 2016-08-01 | 12 |
Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
Total of all active and inactive participants | 2016-08-01 | 304 |
2015: SKC, INC. - HEALTH & WELFARE PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-08-01 | 354 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 330 |
Number of retired or separated participants receiving benefits | 2015-08-01 | 10 |
Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
Total of all active and inactive participants | 2015-08-01 | 340 |
2014: SKC, INC. - HEALTH & WELFARE PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-08-01 | 347 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 350 |
Number of retired or separated participants receiving benefits | 2014-08-01 | 4 |
Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
Total of all active and inactive participants | 2014-08-01 | 354 |
2013: SKC, INC. - HEALTH & WELFARE PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-08-01 | 302 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 345 |
Number of retired or separated participants receiving benefits | 2013-08-01 | 2 |
Total of all active and inactive participants | 2013-08-01 | 347 |
Total participants | 2013-08-01 | 347 |
2012: SKC, INC. - HEALTH & WELFARE PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-08-01 | 314 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 302 |
Number of retired or separated participants receiving benefits | 2012-08-01 | 1 |
Total of all active and inactive participants | 2012-08-01 | 303 |
Total participants | 2012-08-01 | 303 |
2011: SKC, INC. - HEALTH & WELFARE PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-12-01 | 319 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 314 |
Number of retired or separated participants receiving benefits | 2011-12-01 | 2 |
Total of all active and inactive participants | 2011-12-01 | 316 |
Total participants | 2011-12-01 | 316 |
2010: SKC, INC. - HEALTH & WELFARE PLAN 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-12-01 | 291 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 319 |
Number of retired or separated participants receiving benefits | 2010-12-01 | 4 |
Total of all active and inactive participants | 2010-12-01 | 323 |
Total participants | 2010-12-01 | 323 |
2009: SKC, INC. - HEALTH & WELFARE PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-12-01 | 270 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 291 |
Number of retired or separated participants receiving benefits | 2009-12-01 | 10 |
Total of all active and inactive participants | 2009-12-01 | 301 |
Total participants | 2009-12-01 | 301 |
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 2 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 534 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $2,399 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,917 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,399 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6028 |
Policy instance | 1 |
Insurance contract or identification number | GA6028 | Number of Individuals Covered | 538 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $145,918 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,003,078 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $145,918 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 3 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 214 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $58,776 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $391,838 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $58,776 | Insurance broker organization code? | 3 |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 624 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $11,311 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $251,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,311 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 2 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 616 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $185,888 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,141,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $185,888 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 3 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 634 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $2,455 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,455 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 4 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 243 | Insurance policy start date | 2021-08-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $57,135 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $380,903 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57,135 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 4 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 229 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $54,911 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $366,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,911 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 3 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 622 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $2,238 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,428 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,238 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 2 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 612 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $180,124 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,070,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $180,124 | Insurance broker organization code? | 3 |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 612 | Insurance policy start date | 2020-08-01 | Insurance policy end date | 2021-07-31 | Total amount of commissions paid to insurance broker | USD $10,585 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $239,237 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,585 | Insurance broker organization code? | 3 |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 617 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $13,443 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $310,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,443 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 2 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 617 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $173,613 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,008,523 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $173,613 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 3 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 626 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $2,236 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,401 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,236 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 4 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 225 | Insurance policy start date | 2019-08-01 | Insurance policy end date | 2020-07-31 | Total amount of commissions paid to insurance broker | USD $53,646 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $357,638 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $53,646 | Insurance broker organization code? | 3 |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 4 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 231 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $48,925 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $326,168 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $48,925 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 3 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 623 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $2,234 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,234 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 2 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 616 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $134,794 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,862,993 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $134,794 | Insurance broker organization code? | 3 |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 618 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2019-07-31 | Total amount of commissions paid to insurance broker | USD $8,604 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $228,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,604 | Insurance broker organization code? | 3 |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 656 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $9,958 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $252,478 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,958 | Insurance broker name | HAVEN BENEFITS |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 2 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 651 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $156,006 | Welfare Benefit Premiums Paid to Carrier | USD $3,821,045 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $156,006 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 98231211001 |
Policy instance | 3 |
Insurance contract or identification number | 98231211001 | Number of Individuals Covered | 680 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $2,489 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,313 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,489 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00540851 |
Policy instance | 4 |
Insurance contract or identification number | 00540851 | Number of Individuals Covered | 233 | Insurance policy start date | 2017-08-01 | Insurance policy end date | 2018-07-31 | Total amount of commissions paid to insurance broker | USD $49,391 | Total amount of fees paid to insurance company | USD $2,276 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $329,272 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $49,391 | Amount paid for insurance broker fees | 2276 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 965819 |
Policy instance | 2 |
Insurance contract or identification number | OK 965819 | Number of Individuals Covered | 386 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $2,747 | Total amount of fees paid to insurance company | USD $345 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $18,310 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,747 | Amount paid for insurance broker fees | 345 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751010 |
Policy instance | 7 |
Insurance contract or identification number | LK 751010 | Number of Individuals Covered | 386 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $19,110 | Total amount of fees paid to insurance company | USD $2,301 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $127,400 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,110 | Amount paid for insurance broker fees | 2301 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLK960565 |
Policy instance | 6 |
Insurance contract or identification number | FLK960565 | Number of Individuals Covered | 386 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $16,772 | Total amount of fees paid to insurance company | USD $2,107 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $111,813 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,772 | Amount paid for insurance broker fees | 2107 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX964211 |
Policy instance | 5 |
Insurance contract or identification number | FLX964211 | Number of Individuals Covered | 798 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $35,071 | Total amount of fees paid to insurance company | USD $4,231 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $234,185 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,071 | Amount paid for insurance broker fees | 4231 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 899 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $343,279 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 3 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 622 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $233,310 | Welfare Benefit Premiums Paid to Carrier | USD $4,536,635 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $233,310 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9823121 |
Policy instance | 4 |
Insurance contract or identification number | 9823121 | Number of Individuals Covered | 900 | Insurance policy start date | 2015-08-01 | Insurance policy end date | 2016-07-31 | Total amount of commissions paid to insurance broker | USD $3,360 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,494 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,360 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 965819 |
Policy instance | 2 |
Insurance contract or identification number | OK 965819 | Number of Individuals Covered | 386 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $2,591 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $17,272 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,591 | Additional information about fees paid to insurance broker | SALES & SERVICE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GO386 |
Policy instance | 3 |
Insurance contract or identification number | GO386 | Number of Individuals Covered | 668 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $260,761 | Welfare Benefit Premiums Paid to Carrier | USD $4,640,991 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $260,761 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX964211 |
Policy instance | 5 |
Insurance contract or identification number | FLX964211 | Number of Individuals Covered | 798 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $29,767 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $198,445 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,767 | Additional information about fees paid to insurance broker | SALES & SERVICE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLK960565 |
Policy instance | 6 |
Insurance contract or identification number | FLK960565 | Number of Individuals Covered | 386 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $15,834 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $105,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,834 | Additional information about fees paid to insurance broker | SALES & SERVICE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751010 |
Policy instance | 7 |
Insurance contract or identification number | LK 751010 | Number of Individuals Covered | 386 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $16,367 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $109,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,367 | Additional information about fees paid to insurance broker | SALES & SERVICE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9823121 |
Policy instance | 4 |
Insurance contract or identification number | 9823121 | Number of Individuals Covered | 972 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Total amount of commissions paid to insurance broker | USD $3,075 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,075 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GO385 |
Policy instance | 1 |
Insurance contract or identification number | GO385 | Number of Individuals Covered | 933 | Insurance policy start date | 2014-08-01 | Insurance policy end date | 2015-07-31 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $366,154 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GA6028 |
Policy instance | 1 |
Insurance contract or identification number | GA6028 | Number of Individuals Covered | 926 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $206,730 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $358,849 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $206,730 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 965819 |
Policy instance | 2 |
Insurance contract or identification number | OK 965819 | Number of Individuals Covered | 356 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $2,310 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $15,435 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,310 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6028 |
Policy instance | 3 |
Insurance contract or identification number | GA6028 | Number of Individuals Covered | 926 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $3,990,737 | 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 | 9823121 |
Policy instance | 4 |
Insurance contract or identification number | 9823121 | Number of Individuals Covered | 941 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $3,382 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,305 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,382 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX64211 |
Policy instance | 5 |
Insurance contract or identification number | FLX64211 | Number of Individuals Covered | 796 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $27,807 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $185,382 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,807 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLK960565 |
Policy instance | 6 |
Insurance contract or identification number | FLK960565 | Number of Individuals Covered | 488 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $14,245 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,245 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751010 |
Policy instance | 7 |
Insurance contract or identification number | LK 751010 | Number of Individuals Covered | 356 | Insurance policy start date | 2013-08-01 | Insurance policy end date | 2014-07-31 | Total amount of commissions paid to insurance broker | USD $14,414 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $96,777 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,414 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | GA6028 |
Policy instance | 1 |
Insurance contract or identification number | GA6028 | Number of Individuals Covered | 858 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $211,359 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,193,209 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $180,030 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 965819 |
Policy instance | 2 |
Insurance contract or identification number | OK 965819 | Number of Individuals Covered | 304 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $2,196 | Total amount of fees paid to insurance company | USD $220 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $14,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,640 | Amount paid for insurance broker fees | 220 | Additional information about fees paid to insurance broker | SALES & SERVICE OVRERIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | GA6028 |
Policy instance | 3 |
Insurance contract or identification number | GA6028 | Number of Individuals Covered | 721 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $2,830,193 | 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 | FLX64211 |
Policy instance | 5 |
Insurance contract or identification number | FLX64211 | Number of Individuals Covered | 816 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $26,455 | Total amount of fees paid to insurance company | USD $2,601 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $176,363 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,660 | Amount paid for insurance broker fees | 2601 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9823121 |
Policy instance | 4 |
Insurance contract or identification number | 9823121 | Number of Individuals Covered | 871 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $2,809 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $28,085 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,789 | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLK960565 |
Policy instance | 6 |
Insurance contract or identification number | FLK960565 | Number of Individuals Covered | 417 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $13,575 | Total amount of fees paid to insurance company | USD $1,347 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $89,605 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,027 | Amount paid for insurance broker fees | 1347 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 751010 |
Policy instance | 7 |
Insurance contract or identification number | LK 751010 | Number of Individuals Covered | 286 | Insurance policy start date | 2012-08-01 | Insurance policy end date | 2013-07-31 | Total amount of commissions paid to insurance broker | USD $13,602 | Total amount of fees paid to insurance company | USD $1,361 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $90,677 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,138 | Amount paid for insurance broker fees | 1361 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | HAVEN BENEFITS, INC |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9823121 |
Policy instance | 4 |
Insurance contract or identification number | 9823121 | Number of Individuals Covered | 883 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $2,041 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,411 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) |
Policy contract number | 1013100000 |
Policy instance | 3 |
Insurance contract or identification number | 1013100000 | Number of Individuals Covered | 755 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-07-31 | Welfare Benefit Premiums Paid to Carrier | USD $5,361,744 | 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 | 0582248516-0000 |
Policy instance | 2 |
Insurance contract or identification number | 0582248516-0000 | Number of Individuals Covered | 330 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $37,154 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ADD | Welfare Benefit Premiums Paid to Carrier | USD $247,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | 1013100000 |
Policy instance | 1 |
Insurance contract or identification number | 1013100000 | Number of Individuals Covered | 904 | Insurance policy start date | 2011-12-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $127,296 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,265,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05751394 |
Policy instance | 3 |
Insurance contract or identification number | TM05751394 | Number of Individuals Covered | 1342 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $14,530 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $185,526 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 ) |
Policy contract number | 1013100000 |
Policy instance | 1 |
Insurance contract or identification number | 1013100000 | Number of Individuals Covered | 912 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $154,726 | Total amount of fees paid to insurance company | USD $3,892 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,191,945 | 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 | 0582248516-0000 |
Policy instance | 2 |
Insurance contract or identification number | 0582248516-0000 | Number of Individuals Covered | 309 | Insurance policy start date | 2010-12-01 | Insurance policy end date | 2011-11-30 | Total amount of commissions paid to insurance broker | USD $13,843 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $92,289 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|