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SKC, INC. - HEALTH & WELFARE PLAN 401k Plan overview

Plan NameSKC, INC. - HEALTH & WELFARE PLAN
Plan identification number 501

SKC, INC. - HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

SKC, INC. has sponsored the creation of one or more 401k plans.

Company Name:SKC, INC.
Employer identification number (EIN):582248516
NAIC Classification:326100

Additional information about SKC, INC.

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date: 1983-08-12
Company Identification Number: 654123
Legal Registered Office Address: PO BOX 2186

AUGUSTA
United States of America (USA)
30903-2186

More information about SKC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SKC, INC. - HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-08-01
5012021-08-01
5012020-08-01
5012019-08-01
5012018-08-01
5012017-08-01CAROL JONES
5012017-08-01CAROL JONES
5012017-08-01CAROL JONES
5012016-08-01CAROL JONES
5012015-08-01CAROL JONES
5012014-08-01CAROL JONES
5012013-08-01CAROL JONES
5012012-08-01CAROL JONES
5012011-12-01HO JIN KIM
5012010-12-01HO JIN KIM
5012009-12-01HO JIN KIM

Plan Statistics for 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-year2022-08-01248
Total number of active participants reported on line 7a of the Form 55002022-08-01218
Number of retired or separated participants receiving benefits2022-08-012
Number of other retired or separated participants entitled to future benefits2022-08-010
Total of all active and inactive participants2022-08-01220
2021: SKC, INC. - HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01231
Total number of active participants reported on line 7a of the Form 55002021-08-01245
Number of retired or separated participants receiving benefits2021-08-013
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-01248
2020: SKC, INC. - HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01228
Total number of active participants reported on line 7a of the Form 55002020-08-01228
Number of retired or separated participants receiving benefits2020-08-013
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01231
2019: SKC, INC. - HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01229
Total number of active participants reported on line 7a of the Form 55002019-08-01225
Number of retired or separated participants receiving benefits2019-08-013
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01228
2018: SKC, INC. - HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01248
Total number of active participants reported on line 7a of the Form 55002018-08-01228
Number of retired or separated participants receiving benefits2018-08-011
Number of other retired or separated participants entitled to future benefits2018-08-010
Total of all active and inactive participants2018-08-01229
2017: SKC, INC. - HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01304
Total number of active participants reported on line 7a of the Form 55002017-08-01242
Number of retired or separated participants receiving benefits2017-08-016
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01248
2016: SKC, INC. - HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01340
Total number of active participants reported on line 7a of the Form 55002016-08-01292
Number of retired or separated participants receiving benefits2016-08-0112
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01304
2015: SKC, INC. - HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01354
Total number of active participants reported on line 7a of the Form 55002015-08-01330
Number of retired or separated participants receiving benefits2015-08-0110
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01340
2014: SKC, INC. - HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01347
Total number of active participants reported on line 7a of the Form 55002014-08-01350
Number of retired or separated participants receiving benefits2014-08-014
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01354
2013: SKC, INC. - HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01302
Total number of active participants reported on line 7a of the Form 55002013-08-01345
Number of retired or separated participants receiving benefits2013-08-012
Total of all active and inactive participants2013-08-01347
Total participants2013-08-01347
2012: SKC, INC. - HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01314
Total number of active participants reported on line 7a of the Form 55002012-08-01302
Number of retired or separated participants receiving benefits2012-08-011
Total of all active and inactive participants2012-08-01303
Total participants2012-08-01303
2011: SKC, INC. - HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01319
Total number of active participants reported on line 7a of the Form 55002011-12-01314
Number of retired or separated participants receiving benefits2011-12-012
Total of all active and inactive participants2011-12-01316
Total participants2011-12-01316
2010: SKC, INC. - HEALTH & WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01291
Total number of active participants reported on line 7a of the Form 55002010-12-01319
Number of retired or separated participants receiving benefits2010-12-014
Total of all active and inactive participants2010-12-01323
Total participants2010-12-01323
2009: SKC, INC. - HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01270
Total number of active participants reported on line 7a of the Form 55002009-12-01291
Number of retired or separated participants receiving benefits2009-12-0110
Total of all active and inactive participants2009-12-01301
Total participants2009-12-01301

Form 5500 Responses for SKC, INC. - HEALTH & WELFARE PLAN

2022: SKC, INC. - HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – InsuranceYes
2021: SKC, INC. - HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – InsuranceYes
2020: SKC, INC. - HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – InsuranceYes
2019: SKC, INC. - HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – InsuranceYes
2018: SKC, INC. - HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – InsuranceYes
2017: SKC, INC. - HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: SKC, INC. - HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: SKC, INC. - HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: SKC, INC. - HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: SKC, INC. - HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: SKC, INC. - HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: SKC, INC. - HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – InsuranceYes
2010: SKC, INC. - HEALTH & WELFARE PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan benefit arrangement – InsuranceYes
2009: SKC, INC. - HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 2
Insurance contract or identification number98231211001
Number of Individuals Covered534
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $2,399
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGA6028
Policy instance 1
Insurance contract or identification numberGA6028
Number of Individuals Covered538
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $145,918
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $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 number00540851
Policy instance 3
Insurance contract or identification number00540851
Number of Individuals Covered214
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $58,776
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $391,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered624
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $11,311
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $251,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO386
Policy instance 2
Insurance contract or identification numberGO386
Number of Individuals Covered616
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $185,888
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $185,888
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 3
Insurance contract or identification number98231211001
Number of Individuals Covered634
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $2,455
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 number00540851
Policy instance 4
Insurance contract or identification number00540851
Number of Individuals Covered243
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $57,135
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $380,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 number00540851
Policy instance 4
Insurance contract or identification number00540851
Number of Individuals Covered229
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $54,911
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $366,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,911
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 3
Insurance contract or identification number98231211001
Number of Individuals Covered622
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $2,238
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO386
Policy instance 2
Insurance contract or identification numberGO386
Number of Individuals Covered612
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $180,124
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $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 numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered612
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $10,585
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $239,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered617
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $13,443
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO386
Policy instance 2
Insurance contract or identification numberGO386
Number of Individuals Covered617
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $173,613
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $173,613
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 3
Insurance contract or identification number98231211001
Number of Individuals Covered626
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $2,236
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 number00540851
Policy instance 4
Insurance contract or identification number00540851
Number of Individuals Covered225
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $53,646
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $357,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 number00540851
Policy instance 4
Insurance contract or identification number00540851
Number of Individuals Covered231
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $48,925
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $326,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,925
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 3
Insurance contract or identification number98231211001
Number of Individuals Covered623
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $2,234
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO386
Policy instance 2
Insurance contract or identification numberGO386
Number of Individuals Covered616
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $134,794
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $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 numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered618
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $8,604
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $228,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered656
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $9,958
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $252,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,958
Insurance broker nameHAVEN BENEFITS
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGO386
Policy instance 2
Insurance contract or identification numberGO386
Number of Individuals Covered651
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $156,006
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $156,006
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98231211001
Policy instance 3
Insurance contract or identification number98231211001
Number of Individuals Covered680
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $2,489
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,489
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00540851
Policy instance 4
Insurance contract or identification number00540851
Number of Individuals Covered233
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $49,391
Total amount of fees paid to insurance companyUSD $2,276
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $329,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,391
Amount paid for insurance broker fees2276
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 965819
Policy instance 2
Insurance contract or identification numberOK 965819
Number of Individuals Covered386
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $2,747
Total amount of fees paid to insurance companyUSD $345
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $18,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,747
Amount paid for insurance broker fees345
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 751010
Policy instance 7
Insurance contract or identification numberLK 751010
Number of Individuals Covered386
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $19,110
Total amount of fees paid to insurance companyUSD $2,301
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,110
Amount paid for insurance broker fees2301
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960565
Policy instance 6
Insurance contract or identification numberFLK960565
Number of Individuals Covered386
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $16,772
Total amount of fees paid to insurance companyUSD $2,107
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,772
Amount paid for insurance broker fees2107
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964211
Policy instance 5
Insurance contract or identification numberFLX964211
Number of Individuals Covered798
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $35,071
Total amount of fees paid to insurance companyUSD $4,231
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $234,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,071
Amount paid for insurance broker fees4231
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered899
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGO386
Policy instance 3
Insurance contract or identification numberGO386
Number of Individuals Covered622
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $233,310
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $233,310
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9823121
Policy instance 4
Insurance contract or identification number9823121
Number of Individuals Covered900
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Total amount of commissions paid to insurance brokerUSD $3,360
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,360
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 965819
Policy instance 2
Insurance contract or identification numberOK 965819
Number of Individuals Covered386
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $2,591
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $17,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,591
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGO386
Policy instance 3
Insurance contract or identification numberGO386
Number of Individuals Covered668
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $260,761
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $260,761
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX964211
Policy instance 5
Insurance contract or identification numberFLX964211
Number of Individuals Covered798
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $29,767
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $198,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,767
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960565
Policy instance 6
Insurance contract or identification numberFLK960565
Number of Individuals Covered386
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $15,834
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,834
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 751010
Policy instance 7
Insurance contract or identification numberLK 751010
Number of Individuals Covered386
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $16,367
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,367
Additional information about fees paid to insurance brokerSALES & SERVICE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9823121
Policy instance 4
Insurance contract or identification number9823121
Number of Individuals Covered972
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $3,075
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,075
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberGO385
Policy instance 1
Insurance contract or identification numberGO385
Number of Individuals Covered933
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGA6028
Policy instance 1
Insurance contract or identification numberGA6028
Number of Individuals Covered926
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $206,730
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $358,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $206,730
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 965819
Policy instance 2
Insurance contract or identification numberOK 965819
Number of Individuals Covered356
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $2,310
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $15,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,310
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGA6028
Policy instance 3
Insurance contract or identification numberGA6028
Number of Individuals Covered926
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Welfare Benefit Premiums Paid to CarrierUSD $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 number9823121
Policy instance 4
Insurance contract or identification number9823121
Number of Individuals Covered941
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $3,382
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,382
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX64211
Policy instance 5
Insurance contract or identification numberFLX64211
Number of Individuals Covered796
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $27,807
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $185,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,807
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960565
Policy instance 6
Insurance contract or identification numberFLK960565
Number of Individuals Covered488
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $14,245
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,245
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 751010
Policy instance 7
Insurance contract or identification numberLK 751010
Number of Individuals Covered356
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $14,414
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,414
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract numberGA6028
Policy instance 1
Insurance contract or identification numberGA6028
Number of Individuals Covered858
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $211,359
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $180,030
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK 965819
Policy instance 2
Insurance contract or identification numberOK 965819
Number of Individuals Covered304
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $2,196
Total amount of fees paid to insurance companyUSD $220
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $14,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,640
Amount paid for insurance broker fees220
Additional information about fees paid to insurance brokerSALES & SERVICE OVRERIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGA6028
Policy instance 3
Insurance contract or identification numberGA6028
Number of Individuals Covered721
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Welfare Benefit Premiums Paid to CarrierUSD $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 numberFLX64211
Policy instance 5
Insurance contract or identification numberFLX64211
Number of Individuals Covered816
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $26,455
Total amount of fees paid to insurance companyUSD $2,601
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,660
Amount paid for insurance broker fees2601
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9823121
Policy instance 4
Insurance contract or identification number9823121
Number of Individuals Covered871
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $2,809
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,789
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLK960565
Policy instance 6
Insurance contract or identification numberFLK960565
Number of Individuals Covered417
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $13,575
Total amount of fees paid to insurance companyUSD $1,347
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,027
Amount paid for insurance broker fees1347
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK 751010
Policy instance 7
Insurance contract or identification numberLK 751010
Number of Individuals Covered286
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $13,602
Total amount of fees paid to insurance companyUSD $1,361
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,138
Amount paid for insurance broker fees1361
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker organization code?3
Insurance broker nameHAVEN BENEFITS, INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9823121
Policy instance 4
Insurance contract or identification number9823121
Number of Individuals Covered883
Insurance policy start date2011-12-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $2,041
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number1013100000
Policy instance 3
Insurance contract or identification number1013100000
Number of Individuals Covered755
Insurance policy start date2011-12-01
Insurance policy end date2012-07-31
Welfare Benefit Premiums Paid to CarrierUSD $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 number0582248516-0000
Policy instance 2
Insurance contract or identification number0582248516-0000
Number of Individuals Covered330
Insurance policy start date2011-12-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $37,154
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $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 number1013100000
Policy instance 1
Insurance contract or identification number1013100000
Number of Individuals Covered904
Insurance policy start date2011-12-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $127,296
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberTM05751394
Policy instance 3
Insurance contract or identification numberTM05751394
Number of Individuals Covered1342
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $14,530
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number1013100000
Policy instance 1
Insurance contract or identification number1013100000
Number of Individuals Covered912
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $154,726
Total amount of fees paid to insurance companyUSD $3,892
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number0582248516-0000
Policy instance 2
Insurance contract or identification number0582248516-0000
Number of Individuals Covered309
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $13,843
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $92,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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