PRO TRANSPORT-1 LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PRO TRANSPORT-1 LLC HEALTH & WELFARE PLAN
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000018606 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000018606 | | Number of Individuals Covered | 295 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $14,996 | | Total amount of fees paid to insurance company | USD $450 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $74,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,996 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 450 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3341899 |
| Policy instance | 12 |
| Insurance contract or identification number | 3341899 | | Number of Individuals Covered | 416 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $271,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 173 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $301 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $710,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 301 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 3 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1191 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $17,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 4 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,642 | | Total amount of fees paid to insurance company | USD $148 | | Other welfare benefits provided | VOLUNTARY: LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $23,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,642 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 148 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 787 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $129 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 129 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $12,958 | | Total amount of fees paid to insurance company | USD $435 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,958 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 435 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 8 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,353 | | Total amount of fees paid to insurance company | USD $1,025 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $37,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,232 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1025 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,332 | | Total amount of fees paid to insurance company | USD $499 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $75,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,332 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 499 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 10 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $250 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $663,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 250 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 909640 |
| Policy instance | 11 |
| Insurance contract or identification number | 909640 | | Number of Individuals Covered | 169 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $938,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 3 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1335 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $18,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000018606 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000018606 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,009 | | Total amount of fees paid to insurance company | USD $945 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $60,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,009 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 945 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 4 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,949 | | Total amount of fees paid to insurance company | USD $322 | | Other welfare benefits provided | VOLUNTARY: LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $19,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,949 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 322 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $2,169 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $697,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2169 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 366 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 797 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of fees paid to insurance company | USD $281 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 281 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $11,592 | | Total amount of fees paid to insurance company | USD $1,146 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $57,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,592 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1146 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 8 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $10,846 | | Total amount of fees paid to insurance company | USD $1,404 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $36,793 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,713 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1404 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,981 | | Total amount of fees paid to insurance company | USD $875 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,539 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,981 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 875 | | Additional information about fees paid to insurance broker | BROKER BONUS |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 10 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $621,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0909640 |
| Policy instance | 11 |
| Insurance contract or identification number | 0909640 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $991,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3341899 |
| Policy instance | 12 |
| Insurance contract or identification number | 3341899 | | Number of Individuals Covered | 451 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $272,261 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000018606 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000018606 | | Number of Individuals Covered | 371 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,893 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $24,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,893 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 4 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,597 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,597 | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 3 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1504 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $6,951 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,055,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 443 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 920 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $7,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,756 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,756 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,281 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,281 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 10 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $847,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0909640 |
| Policy instance | 11 |
| Insurance contract or identification number | 0909640 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $419,266 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3341899 |
| Policy instance | 12 |
| Insurance contract or identification number | 3341899 | | Number of Individuals Covered | 556 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 8 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,162 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,162 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 18606 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000 18606 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $14,772 | | Total amount of fees paid to insurance company | USD $2,141 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $73,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,772 | | Amount paid for insurance broker fees | 2141 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 4 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $5,378 | | Total amount of fees paid to insurance company | USD $852 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,378 | | Amount paid for insurance broker fees | 852 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 3 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1400 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $24,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $452,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 475 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 969 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of fees paid to insurance company | USD $712 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $23,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 712 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $19,894 | | Total amount of fees paid to insurance company | USD $2,874 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $99,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,894 | | Amount paid for insurance broker fees | 2874 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3341899 |
| Policy instance | 12 |
| Insurance contract or identification number | 3341899 | | Number of Individuals Covered | 583 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of fees paid to insurance company | USD $2,220 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $325,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2220 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0909640 |
| Policy instance | 11 |
| Insurance contract or identification number | 0909640 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,494,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 10 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $298,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $12,012 | | Total amount of fees paid to insurance company | USD $3,083 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $80,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,012 | | Amount paid for insurance broker fees | 3083 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 8 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $14,919 | | Total amount of fees paid to insurance company | USD $2,620 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,593 | | Amount paid for insurance broker fees | 2620 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $13,428 | | Total amount of fees paid to insurance company | USD $1,735 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,428 | | Amount paid for insurance broker fees | 1735 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 8 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 343 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $15,344 | | Total amount of fees paid to insurance company | USD $2,959 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $59,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,988 | | Amount paid for insurance broker fees | 2959 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 9 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $13,230 | | Total amount of fees paid to insurance company | USD $3,246 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,230 | | Amount paid for insurance broker fees | 3246 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 16819 |
| Policy instance | 10 |
| Insurance contract or identification number | 16819 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 11 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $777,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 909640 |
| Policy instance | 12 |
| Insurance contract or identification number | 909640 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,148,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 17553 |
| Policy instance | 13 |
| Insurance contract or identification number | 17553 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3341899 |
| Policy instance | 14 |
| Insurance contract or identification number | 3341899 | | Number of Individuals Covered | 652 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $317,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 1182 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of fees paid to insurance company | USD $731 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 731 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 18606 |
| Policy instance | 5 |
| Insurance contract or identification number | 400001000 18606 | | Number of Individuals Covered | 474 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $12,733 | | Total amount of fees paid to insurance company | USD $2,630 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $63,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,733 | | Amount paid for insurance broker fees | 2630 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 4 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 381 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $4,848 | | Total amount of fees paid to insurance company | USD $1,014 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $24,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,848 | | Amount paid for insurance broker fees | 1014 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 3 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1710 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $27,058 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,263,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 531 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 1298 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of fees paid to insurance company | USD $96 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 18606 |
| Policy instance | 6 |
| Insurance contract or identification number | 400001000 18606 | | Number of Individuals Covered | 502 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $15,188 | | Total amount of fees paid to insurance company | USD $383 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $75,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 5 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 389 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $5,711 | | Total amount of fees paid to insurance company | USD $133 | | Other welfare benefits provided | VOLUNTARY AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $28,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 001706 |
| Policy instance | 4 |
| Insurance contract or identification number | 001706 | | Number of Individuals Covered | 1864 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $26,623 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 9297 |
| Policy instance | 3 |
| Insurance contract or identification number | 9297 | | Number of Individuals Covered | 440 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $189,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,366,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 590 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 8 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 380 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $7,995 | | Total amount of fees paid to insurance company | USD $177 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,973 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 9 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 370 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $21,081 | | Total amount of fees paid to insurance company | USD $2,233 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $76,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 17553 |
| Policy instance | 15 |
| Insurance contract or identification number | 17553 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDTRANS (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | STOP LOSS |
| Policy instance | 16 |
| Insurance contract or identification number | STOP LOSS | | Number of Individuals Covered | 61 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $199,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 909640 |
| Policy instance | 14 |
| Insurance contract or identification number | 909640 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $860,373 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 13 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 230 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $838,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 16819 |
| Policy instance | 12 |
| Insurance contract or identification number | 16819 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 16559 |
| Policy instance | 11 |
| Insurance contract or identification number | 16559 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 10 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $12,795 | | Total amount of fees paid to insurance company | USD $334 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193955 |
| Policy instance | 7 |
| Insurance contract or identification number | 000010193955 | | Number of Individuals Covered | 1213 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of fees paid to insurance company | USD $247 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $16,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 247 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 18606 |
| Policy instance | 6 |
| Insurance contract or identification number | 400001000 18606 | | Number of Individuals Covered | 410 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $12,516 | | Total amount of fees paid to insurance company | USD $777 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $59,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $538 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 777 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 5 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $4,653 | | Total amount of fees paid to insurance company | USD $283 | | Other welfare benefits provided | VOLUNTARY LIFE AND AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $21,949 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $235 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 283 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 1706 |
| Policy instance | 4 |
| Insurance contract or identification number | 1706 | | Number of Individuals Covered | 1566 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $20,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 9297 |
| Policy instance | 3 |
| Insurance contract or identification number | 9297 | | Number of Individuals Covered | 526 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $226,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 403 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,607,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010193956 |
| Policy instance | 8 |
| Insurance contract or identification number | 000010193956 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $5,654 | | Total amount of fees paid to insurance company | USD $467 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $338 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 467 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 466 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 9 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $24,698 | | Total amount of fees paid to insurance company | USD $4,233 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,607 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4233 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | NONE |
| Policy instance | 16 |
| Insurance contract or identification number | NONE | | Number of Individuals Covered | 53 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $144,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 230484 |
| Policy instance | 15 |
| Insurance contract or identification number | 230484 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $385,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 16819 |
| Policy instance | 14 |
| Insurance contract or identification number | 16819 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 16559 |
| Policy instance | 13 |
| Insurance contract or identification number | 16559 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 15860 |
| Policy instance | 12 |
| Insurance contract or identification number | 15860 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,560 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) |
| Policy contract number | 15860 |
| Policy instance | 11 |
| Insurance contract or identification number | 15860 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $19,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,206 | | Insurance broker organization code? | 3 | | Insurance broker name | JAMES F TULLIS & ASSOC INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010206791 |
| Policy instance | 10 |
| Insurance contract or identification number | 000010206791 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2015-09-01 | | Insurance policy end date | 2016-08-31 | | Total amount of commissions paid to insurance broker | USD $6,610 | | Total amount of fees paid to insurance company | USD $2,399 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,610 | | Amount paid for insurance broker fees | 2399 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 9297 |
| Policy instance | 3 |
| Insurance contract or identification number | 9297 | | Number of Individuals Covered | 532 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $197,954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of fees paid to insurance company | USD $7,500 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,276,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7500 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 1706 |
| Policy instance | 4 |
| Insurance contract or identification number | 1706 | | Number of Individuals Covered | 912 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $13,408 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000403002951 |
| Policy instance | 5 |
| Insurance contract or identification number | 000403002951 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $1,658 | | Total amount of fees paid to insurance company | USD $257 | | Other welfare benefits provided | VOLUNTARY LIFE AND AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $8,294 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $829 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 257 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 400001000 18606 |
| Policy instance | 6 |
| Insurance contract or identification number | 400001000 18606 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $4,764 | | Total amount of fees paid to insurance company | USD $695 | | Other welfare benefits provided | VOLUNTARY LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $23,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,382 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 695 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10193955 |
| Policy instance | 7 |
| Insurance contract or identification number | 10193955 | | Number of Individuals Covered | 622 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of fees paid to insurance company | USD $393 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $7,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10193956 |
| Policy instance | 8 |
| Insurance contract or identification number | 10193956 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $3,230 | | Total amount of fees paid to insurance company | USD $416 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,615 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 416 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000404003210 |
| Policy instance | 9 |
| Insurance contract or identification number | 000404003210 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $28,651 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $44,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,651 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID WIGGINS |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 30042213 |
| Policy instance | 1 |
| Insurance contract or identification number | 30042213 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 9297 |
| Policy instance | 3 |
| Insurance contract or identification number | 9297 | | Number of Individuals Covered | 313 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $1,286 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $156,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,100 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 1706 |
| Policy instance | 4 |
| Insurance contract or identification number | 1706 | | Number of Individuals Covered | 726 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $17 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $9,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES LLC |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | BH591 |
| Policy instance | 6 |
| Insurance contract or identification number | BH591 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $4,054 | | Total amount of fees paid to insurance company | USD $195 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,685 | | Amount paid for insurance broker fees | 97 | | Additional information about fees paid to insurance broker | BROKER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY FRANCIS RANUIO |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 232554 |
| Policy instance | 5 |
| Insurance contract or identification number | 232554 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $220,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $-84 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $214,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $-84 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-037108 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-037108 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $1,265 | | Total amount of fees paid to insurance company | USD $251 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 251 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker name | VANTREO INSURANCE BROKERAGE |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | BH591 |
| Policy instance | 6 |
| Insurance contract or identification number | BH591 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $5,814 | | Health Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,712 | | Insurance broker organization code? | 3 | | Insurance broker name | MAYRA M. CUARENTA |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10058 |
| Policy instance | 5 |
| Insurance contract or identification number | SL10058 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Welfare Benefit Premiums Paid to Carrier | USD $205,709 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 1706 |
| Policy instance | 4 |
| Insurance contract or identification number | 1706 | | Number of Individuals Covered | 779 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $516 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $10,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $516 | | Insurance broker organization code? | 3 | | Insurance broker name | SALMON, ROY BOURDETT |
|
| PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 ) |
| Policy contract number | 9297 |
| Policy instance | 3 |
| Insurance contract or identification number | 9297 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $5,851 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $155,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,851 | | Insurance broker organization code? | 3 | | Insurance broker name | VANTREO INSURANCE BROKERAGE |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 603238 |
| Policy instance | 2 |
| Insurance contract or identification number | 603238 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | Total amount of commissions paid to insurance broker | USD $16,149 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $322,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,943 | | Insurance broker organization code? | 3 | | Insurance broker name | LOCKTON COMPANIES, LLC |
|
