IOWA TRIBE OF OKLAHOMA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN
Measure | Date | Value |
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2022: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 518 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 310 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 15 |
Total of all active and inactive participants | 2022-01-01 | 326 |
Total participants | 2022-01-01 | 326 |
2021: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 494 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 506 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 10 |
Total of all active and inactive participants | 2021-01-01 | 518 |
Total participants | 2021-01-01 | 518 |
2020: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 419 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 478 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 16 |
Total of all active and inactive participants | 2020-01-01 | 494 |
Total participants | 2020-01-01 | 494 |
2019: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 431 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 352 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 11 |
Total of all active and inactive participants | 2019-01-01 | 365 |
Total participants | 2019-01-01 | 365 |
2018: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 436 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 502 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 1 |
Total of all active and inactive participants | 2018-01-01 | 508 |
Total participants | 2018-01-01 | 508 |
2017: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 387 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 424 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 10 |
Total of all active and inactive participants | 2017-01-01 | 436 |
Total participants | 2017-01-01 | 436 |
2016: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 445 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 367 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 20 |
Total of all active and inactive participants | 2016-01-01 | 387 |
Total participants | 2016-01-01 | 387 |
2015: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 302 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 350 |
Number of retired or separated participants receiving benefits | 2015-01-01 | 3 |
Total of all active and inactive participants | 2015-01-01 | 353 |
Total participants | 2015-01-01 | 353 |
2014: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 309 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 351 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 5 |
Total of all active and inactive participants | 2014-01-01 | 356 |
Total participants | 2014-01-01 | 356 |
2013: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 542 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 307 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 2 |
Total of all active and inactive participants | 2013-01-01 | 309 |
Total participants | 2013-01-01 | 309 |
2012: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 421 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 541 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
Total of all active and inactive participants | 2012-01-01 | 542 |
Total participants | 2012-01-01 | 542 |
2011: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 419 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 419 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 2 |
Total of all active and inactive participants | 2011-01-01 | 421 |
Total participants | 2011-01-01 | 421 |
2010: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 377 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 419 |
Total of all active and inactive participants | 2010-01-01 | 419 |
Total participants | 2010-01-01 | 419 |
2009: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 200 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 377 |
Total of all active and inactive participants | 2009-01-01 | 377 |
Total participants | 2009-01-01 | 377 |
2008: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-01-01 | 183 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 194 |
Total of all active and inactive participants | 2008-01-01 | 194 |
Total participants | 2008-01-01 | 194 |
2007: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2007 401k membership |
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Total participants, beginning-of-year | 2007-01-01 | 135 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 147 |
Total of all active and inactive participants | 2007-01-01 | 147 |
Total participants | 2007-01-01 | 147 |
2006: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2006 401k membership |
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Total participants, beginning-of-year | 2006-01-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2006-01-01 | 129 |
Total of all active and inactive participants | 2006-01-01 | 129 |
Total participants | 2006-01-01 | 129 |
2005: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2005 401k membership |
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Total participants, beginning-of-year | 2005-01-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2005-01-01 | 93 |
Total of all active and inactive participants | 2005-01-01 | 93 |
Total participants | 2005-01-01 | 93 |
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F026337 |
Policy instance | 6 |
Insurance contract or identification number | F026337 | Number of Individuals Covered | 291 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,412 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,412 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254072 |
Policy instance | 5 |
Insurance contract or identification number | 10254072 | Number of Individuals Covered | 316 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,077 | Total amount of fees paid to insurance company | USD $100 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,942 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,077 | Amount paid for insurance broker fees | 100 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 254435 |
Policy instance | 4 |
Insurance contract or identification number | 254435 | Number of Individuals Covered | 529 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $20,188 | Total amount of fees paid to insurance company | USD $3,060 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,139,761 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,188 | Amount paid for insurance broker fees | 3060 | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100025285 |
Policy instance | 3 |
Insurance contract or identification number | 40000100025285 | Number of Individuals Covered | 349 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,134 | Total amount of fees paid to insurance company | USD $205 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $41,336 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,134 | Amount paid for insurance broker fees | 205 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254073 |
Policy instance | 2 |
Insurance contract or identification number | 10254073 | Number of Individuals Covered | 83 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,505 | Total amount of fees paid to insurance company | USD $240 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $41,701 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,505 | Amount paid for insurance broker fees | 240 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254071 |
Policy instance | 1 |
Insurance contract or identification number | 10254071 | Number of Individuals Covered | 128 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,268 | Total amount of fees paid to insurance company | USD $131 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,739 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,268 | Amount paid for insurance broker fees | 131 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254071 |
Policy instance | 1 |
Insurance contract or identification number | 10254071 | Number of Individuals Covered | 132 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,363 | Total amount of fees paid to insurance company | USD $248 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,517 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,363 | Amount paid for insurance broker fees | 248 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254073 |
Policy instance | 2 |
Insurance contract or identification number | 10254073 | Number of Individuals Covered | 87 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,581 | Total amount of fees paid to insurance company | USD $493 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $47,094 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,581 | Amount paid for insurance broker fees | 493 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100025285 |
Policy instance | 3 |
Insurance contract or identification number | 40000100025285 | Number of Individuals Covered | 269 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,026 | Total amount of fees paid to insurance company | USD $459 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $40,260 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,026 | Amount paid for insurance broker fees | 459 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 254435 |
Policy instance | 4 |
Insurance contract or identification number | 254435 | Number of Individuals Covered | 541 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $23,262 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,037,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,262 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254072 |
Policy instance | 5 |
Insurance contract or identification number | 10254072 | Number of Individuals Covered | 325 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,124 | Total amount of fees paid to insurance company | USD $232 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $19,349 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,124 | Amount paid for insurance broker fees | 232 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F026337 |
Policy instance | 6 |
Insurance contract or identification number | F026337 | Number of Individuals Covered | 291 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,498 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,498 | Insurance broker organization code? | 3 |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 1 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 334 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $15,515 | Total amount of fees paid to insurance company | USD $16,260 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,515 | Amount paid for insurance broker fees | 16260 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165521001 |
Policy instance | 2 |
Insurance contract or identification number | 10165521001 | Number of Individuals Covered | 259 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,122 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,555 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,122 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165531001 |
Policy instance | 3 |
Insurance contract or identification number | 10165531001 | Number of Individuals Covered | 82 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $441 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $441 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165541001 |
Policy instance | 4 |
Insurance contract or identification number | 10165541001 | Number of Individuals Covered | 278 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,637 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,856 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,637 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254071 |
Policy instance | 5 |
Insurance contract or identification number | 10254071 | Number of Individuals Covered | 107 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $3,254 | Total amount of fees paid to insurance company | USD $108 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,648 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,254 | Amount paid for insurance broker fees | 108 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254073 |
Policy instance | 6 |
Insurance contract or identification number | 10254073 | Number of Individuals Covered | 94 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,624 | Total amount of fees paid to insurance company | USD $231 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $49,053 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,624 | Amount paid for insurance broker fees | 231 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100025285 |
Policy instance | 7 |
Insurance contract or identification number | 40000100025285 | Number of Individuals Covered | 307 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $4,577 | Total amount of fees paid to insurance company | USD $254 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $45,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,577 | Amount paid for insurance broker fees | 254 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 254435 |
Policy instance | 8 |
Insurance contract or identification number | 254435 | Number of Individuals Covered | 652 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $176,820 | Welfare Benefit Premiums Paid to Carrier | USD $3,601,696 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $176,820 | Insurance broker organization code? | 3 |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 1 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 366 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $13,189 | Total amount of fees paid to insurance company | USD $18,894 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,189 | Amount paid for insurance broker fees | 18894 | Additional information about fees paid to insurance broker | ADMINISTRATION FEES | Insurance broker organization code? | 3 |
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LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
Policy contract number | MP0000871309 |
Policy instance | 2 |
Insurance contract or identification number | MP0000871309 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-06-30 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 |
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LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
Policy contract number | MP0000871308 |
Policy instance | 3 |
Insurance contract or identification number | MP0000871308 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-06-30 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 |
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LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
Policy contract number | MP0000871303 |
Policy instance | 4 |
Insurance contract or identification number | MP0000871303 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-06-30 | Temporary Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165521001 |
Policy instance | 5 |
Insurance contract or identification number | 10165521001 | Number of Individuals Covered | 278 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,691 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,691 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165531001 |
Policy instance | 6 |
Insurance contract or identification number | 10165531001 | Number of Individuals Covered | 81 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $511 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $511 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 10165541001 |
Policy instance | 7 |
Insurance contract or identification number | 10165541001 | Number of Individuals Covered | 274 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,808 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,021 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,808 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254072 |
Policy instance | 8 |
Insurance contract or identification number | 10254072 | Number of Individuals Covered | 407 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $856 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $856 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10254071 |
Policy instance | 9 |
Insurance contract or identification number | 10254071 | Number of Individuals Covered | 112 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,622 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,622 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100025285 |
Policy instance | 10 |
Insurance contract or identification number | 40000100025285 | Number of Individuals Covered | 337 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $2,538 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $25,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,538 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 173241 |
Policy instance | 4 |
Insurance contract or identification number | 173241 | Number of Individuals Covered | 690 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $154,206 | Total amount of fees paid to insurance company | USD $4,080 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,846,838 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $-4,214 | Amount paid for insurance broker fees | 4080 | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | F014879 |
Policy instance | 3 |
Insurance contract or identification number | F014879 | Number of Individuals Covered | 391 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $22,251 | Total amount of fees paid to insurance company | USD $9,730 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D; DEP | Welfare Benefit Premiums Paid to Carrier | USD $148,268 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 4468 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $1,878 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 2 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 374 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $10,727 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,727 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 366 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,933 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,140 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,211 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 875574G |
Policy instance | 3 |
Insurance contract or identification number | 875574G | Number of Individuals Covered | 336 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $18,542 | Total amount of fees paid to insurance company | USD $3,040 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D; WD-NST | Welfare Benefit Premiums Paid to Carrier | USD $123,605 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,542 | Amount paid for insurance broker fees | 3040 | Additional information about fees paid to insurance broker | BONUSES PAID | Insurance broker organization code? | 3 | Insurance broker name | MASCHINO HUDELSON & ASSOCIATES |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 2 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 334 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $9,608 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,608 | Insurance broker organization code? | 3 | Insurance broker name | NFP CORPORATE SERVICES, LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 331 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,839 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,738 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,839 | Insurance broker organization code? | 3 | Insurance broker name | NFP CORPORATE SERVICES (OK) LLC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 4 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 342 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $8,269 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,269 | Insurance broker organization code? | 3 | Insurance broker name | MASCHINO HUDELSON & ASSOCIATES |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-016356-00 |
Policy instance | 3 |
Insurance contract or identification number | 01-016356-00 | Number of Individuals Covered | 143 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $5,468 | Total amount of fees paid to insurance company | USD $1,610 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $44,542 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1610 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $5,468 | Insurance broker name | PREMIER CONSULTING PARTNERS, LLC |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-016356-01 |
Policy instance | 2 |
Insurance contract or identification number | 01-016356-01 | Number of Individuals Covered | 213 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $5,151 | Total amount of fees paid to insurance company | USD $1,015 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $42,072 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1015 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $5,151 | Insurance broker name | PREMIER CONSULTING PARTNERS, LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 333 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $1,738 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,373 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,030 | Insurance broker organization code? | 3 | Insurance broker name | NFP CORPORATE SERVICES (OK) LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 252 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $1,472 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,472 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS, INC |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-016356-00 |
Policy instance | 2 |
Insurance contract or identification number | 01-016356-00 | Number of Individuals Covered | 130 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $5,732 | Total amount of fees paid to insurance company | USD $877 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $57,662 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,732 | Amount paid for insurance broker fees | 877 | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
Policy contract number | 01-016356-01 |
Policy instance | 3 |
Insurance contract or identification number | 01-016356-01 | Number of Individuals Covered | 177 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $3,580 | Total amount of fees paid to insurance company | USD $1,091 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $45,276 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,580 | Amount paid for insurance broker fees | 1091 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 1176 |
Policy instance | 4 |
Insurance contract or identification number | 1176 | Number of Individuals Covered | 308 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $4,458 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,458 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 249 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $1,474 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,930 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,474 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS, INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716410 |
Policy instance | 2 |
Insurance contract or identification number | 0716410 | Number of Individuals Covered | 386 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $119,033 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,728,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $119,033 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 868539G |
Policy instance | 3 |
Insurance contract or identification number | 868539G | Number of Individuals Covered | 258 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $8,596 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $83,675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,596 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05988300 |
Policy instance | 4 |
Insurance contract or identification number | KM05988300 | Number of Individuals Covered | 541 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $7,444 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $96,817 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,444 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 263 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $1,496 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,897 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,496 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS, INC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 8234 |
Policy instance | 2 |
Insurance contract or identification number | 8234 | Number of Individuals Covered | 240 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $8,008 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,008 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716410 |
Policy instance | 3 |
Insurance contract or identification number | 0716410 | Number of Individuals Covered | 419 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $139,670 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,594,694 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $139,670 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 868539G |
Policy instance | 4 |
Insurance contract or identification number | 868539G | Number of Individuals Covered | 258 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $9,019 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $90,186 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,019 | Insurance broker organization code? | 3 | Insurance broker name | SPIRIT INS AGENCY INC |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 868539G |
Policy instance | 5 |
Insurance contract or identification number | 868539G | Number of Individuals Covered | 244 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $8,324 | Total amount of fees paid to insurance company | USD $2,836 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $78,725 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,324 | Amount paid for insurance broker fees | 2836 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716410 |
Policy instance | 4 |
Insurance contract or identification number | 0716410 | Number of Individuals Covered | 419 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $82,911 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,956,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,858 | Insurance broker organization code? | 3 | Insurance broker name | PREMIER CONSULTING PARTNERS INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53935 |
Policy instance | 3 |
Insurance contract or identification number | 53935 | Number of Individuals Covered | 210 | Insurance policy start date | 2009-02-01 | Insurance policy end date | 2010-01-31 | Total amount of commissions paid to insurance broker | USD $8,385 | Total amount of fees paid to insurance company | USD $123 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $122,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 123 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $8,385 | Insurance broker name | INSERVICES, INC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 8234 |
Policy instance | 2 |
Insurance contract or identification number | 8234 | Number of Individuals Covered | 252 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $7,109 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,218 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES INC DBA DILLINGHAM INS |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 240 | Insurance policy start date | 2009-04-01 | Insurance policy end date | 2010-03-31 | Total amount of commissions paid to insurance broker | USD $1,400 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,783 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $75 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES, INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 201 | Insurance policy start date | 2008-04-01 | Insurance policy end date | 2009-03-31 | Total amount of commissions paid to insurance broker | USD $1,265 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,297 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,031 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES, INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53935 |
Policy instance | 3 |
Insurance contract or identification number | 53935 | Number of Individuals Covered | 189 | Insurance policy start date | 2008-02-01 | Insurance policy end date | 2009-01-31 | Total amount of commissions paid to insurance broker | USD $9,360 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $124,810 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,526 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES, INC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 8234 |
Policy instance | 2 |
Insurance contract or identification number | 8234 | Number of Individuals Covered | 217 | Insurance policy start date | 2009-01-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $4,622 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,622 | Insurance broker organization code? | 3 | Insurance broker name | SPIRIT INSURANCE AGENCY INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716410 |
Policy instance | 4 |
Insurance contract or identification number | 0716410 | Number of Individuals Covered | 377 | Insurance policy start date | 2009-02-01 | Insurance policy end date | 2009-12-31 | Total amount of commissions paid to insurance broker | USD $61,902 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,289,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,902 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 174 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-03-31 | Total amount of commissions paid to insurance broker | USD $1,028 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,806 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,028 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 8234 |
Policy instance | 2 |
Insurance contract or identification number | 8234 | Number of Individuals Covered | 185 | Insurance policy start date | 2008-01-01 | Insurance policy end date | 2008-12-31 | Total amount of commissions paid to insurance broker | USD $5,173 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,173 | Insurance broker organization code? | 3 | Insurance broker name | INSERVICES INC DBA BILLINGHAM INS |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 53935 |
Policy instance | 3 |
Insurance contract or identification number | 53935 | Number of Individuals Covered | 45 | Insurance policy start date | 2007-04-01 | Insurance policy end date | 2008-01-31 | Total amount of commissions paid to insurance broker | USD $1,769 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,792 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,769 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
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DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) |
Policy contract number | 8234 |
Policy instance | 2 |
Insurance contract or identification number | 8234 | Number of Individuals Covered | 104 | Insurance policy start date | 2007-01-01 | Insurance policy end date | 2007-12-31 | Total amount of commissions paid to insurance broker | USD $3,229 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,229 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12237020 |
Policy instance | 1 |
Insurance contract or identification number | 12237020 | Number of Individuals Covered | 97 | Insurance policy start date | 2006-04-01 | Insurance policy end date | 2007-03-31 | Total amount of commissions paid to insurance broker | USD $773 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $625 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
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