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IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 401k Plan overview

Plan NameIOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN
Plan identification number 501

IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

IOWA TRIBE OF OKLAHOMA has sponsored the creation of one or more 401k plans.

Company Name:IOWA TRIBE OF OKLAHOMA
Employer identification number (EIN):730930652
NAIC Classification:713200
NAIC Description: Gambling Industries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01SHAUN PATTEN2023-10-13
5012021-01-01SHAUN PATTEN2022-10-13
5012020-01-01SHAUN PATTEN2021-10-12
5012019-01-01
5012018-01-01SHAUN PATTEN2019-10-15
5012017-01-01SHAUN PATTEN
5012016-01-01SHAUN PATTEN
5012015-01-01JUDITH SHORES
5012014-01-01JUDITH SHROES
5012013-01-01LISA SWITCH
5012012-01-01GARY PRATT
5012011-01-01GARY PRATT
5012010-01-01GARY PRATT
5012009-01-01GARY PRATT
5012008-01-01GARY PRATT
5012007-01-01GARY PRATT
5012006-01-01GARY PRATT
5012005-01-01GARY PRATT

Plan Statistics for IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN

401k plan membership statisitcs for IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN

Measure Date Value
2022: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01518
Total number of active participants reported on line 7a of the Form 55002022-01-01310
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-0115
Total of all active and inactive participants2022-01-01326
Total participants2022-01-01326
2021: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01494
Total number of active participants reported on line 7a of the Form 55002021-01-01506
Number of retired or separated participants receiving benefits2021-01-012
Number of other retired or separated participants entitled to future benefits2021-01-0110
Total of all active and inactive participants2021-01-01518
Total participants2021-01-01518
2020: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01419
Total number of active participants reported on line 7a of the Form 55002020-01-01478
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0116
Total of all active and inactive participants2020-01-01494
Total participants2020-01-01494
2019: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01431
Total number of active participants reported on line 7a of the Form 55002019-01-01352
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-0111
Total of all active and inactive participants2019-01-01365
Total participants2019-01-01365
2018: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01436
Total number of active participants reported on line 7a of the Form 55002018-01-01502
Number of retired or separated participants receiving benefits2018-01-015
Number of other retired or separated participants entitled to future benefits2018-01-011
Total of all active and inactive participants2018-01-01508
Total participants2018-01-01508
2017: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01387
Total number of active participants reported on line 7a of the Form 55002017-01-01424
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-0110
Total of all active and inactive participants2017-01-01436
Total participants2017-01-01436
2016: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01445
Total number of active participants reported on line 7a of the Form 55002016-01-01367
Number of other retired or separated participants entitled to future benefits2016-01-0120
Total of all active and inactive participants2016-01-01387
Total participants2016-01-01387
2015: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01302
Total number of active participants reported on line 7a of the Form 55002015-01-01350
Number of retired or separated participants receiving benefits2015-01-013
Total of all active and inactive participants2015-01-01353
Total participants2015-01-01353
2014: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01309
Total number of active participants reported on line 7a of the Form 55002014-01-01351
Number of retired or separated participants receiving benefits2014-01-015
Total of all active and inactive participants2014-01-01356
Total participants2014-01-01356
2013: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01542
Total number of active participants reported on line 7a of the Form 55002013-01-01307
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01309
Total participants2013-01-01309
2012: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01421
Total number of active participants reported on line 7a of the Form 55002012-01-01541
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01542
Total participants2012-01-01542
2011: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01419
Total number of active participants reported on line 7a of the Form 55002011-01-01419
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-01421
Total participants2011-01-01421
2010: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01377
Total number of active participants reported on line 7a of the Form 55002010-01-01419
Total of all active and inactive participants2010-01-01419
Total participants2010-01-01419
2009: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01200
Total number of active participants reported on line 7a of the Form 55002009-01-01377
Total of all active and inactive participants2009-01-01377
Total participants2009-01-01377
2008: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01183
Total number of active participants reported on line 7a of the Form 55002008-01-01194
Total of all active and inactive participants2008-01-01194
Total participants2008-01-01194
2007: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01135
Total number of active participants reported on line 7a of the Form 55002007-01-01147
Total of all active and inactive participants2007-01-01147
Total participants2007-01-01147
2006: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01116
Total number of active participants reported on line 7a of the Form 55002006-01-01129
Total of all active and inactive participants2006-01-01129
Total participants2006-01-01129
2005: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01108
Total number of active participants reported on line 7a of the Form 55002005-01-0193
Total of all active and inactive participants2005-01-0193
Total participants2005-01-0193

Form 5500 Responses for IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN

2022: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entityMulti-employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-01-01Type of plan entityMulti-employer plan
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – General assets of the sponsorYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – General assets of the sponsorYes
2007: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2007 form 5500 responses
2007-01-01Type of plan entityMulti-employer plan
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – General assets of the sponsorYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – General assets of the sponsorYes
2006: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2006 form 5500 responses
2006-01-01Type of plan entityMulti-employer plan
2006-01-01Plan funding arrangement – General assets of the sponsorYes
2006-01-01Plan benefit arrangement – General assets of the sponsorYes
2005: IOWA TRIBE OF OKLAHOMA WELFARE BENEFIT PLAN 2005 form 5500 responses
2005-01-01Type of plan entityMulti-employer plan
2005-01-01First time form 5500 has been submittedYes
2005-01-01Plan funding arrangement – General assets of the sponsorYes
2005-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF026337
Policy instance 6
Insurance contract or identification numberF026337
Number of Individuals Covered291
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,412
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,412
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254072
Policy instance 5
Insurance contract or identification number10254072
Number of Individuals Covered316
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,077
Total amount of fees paid to insurance companyUSD $100
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $17,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,077
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number254435
Policy instance 4
Insurance contract or identification number254435
Number of Individuals Covered529
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $20,188
Total amount of fees paid to insurance companyUSD $3,060
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $20,188
Amount paid for insurance broker fees3060
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100025285
Policy instance 3
Insurance contract or identification number40000100025285
Number of Individuals Covered349
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,134
Total amount of fees paid to insurance companyUSD $205
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,134
Amount paid for insurance broker fees205
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254073
Policy instance 2
Insurance contract or identification number10254073
Number of Individuals Covered83
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,505
Total amount of fees paid to insurance companyUSD $240
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $41,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,505
Amount paid for insurance broker fees240
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254071
Policy instance 1
Insurance contract or identification number10254071
Number of Individuals Covered128
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,268
Total amount of fees paid to insurance companyUSD $131
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,268
Amount paid for insurance broker fees131
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254071
Policy instance 1
Insurance contract or identification number10254071
Number of Individuals Covered132
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,363
Total amount of fees paid to insurance companyUSD $248
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,363
Amount paid for insurance broker fees248
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254073
Policy instance 2
Insurance contract or identification number10254073
Number of Individuals Covered87
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,581
Total amount of fees paid to insurance companyUSD $493
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $47,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,581
Amount paid for insurance broker fees493
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100025285
Policy instance 3
Insurance contract or identification number40000100025285
Number of Individuals Covered269
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,026
Total amount of fees paid to insurance companyUSD $459
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,026
Amount paid for insurance broker fees459
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number254435
Policy instance 4
Insurance contract or identification number254435
Number of Individuals Covered541
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $23,262
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $23,262
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254072
Policy instance 5
Insurance contract or identification number10254072
Number of Individuals Covered325
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,124
Total amount of fees paid to insurance companyUSD $232
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,124
Amount paid for insurance broker fees232
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF026337
Policy instance 6
Insurance contract or identification numberF026337
Number of Individuals Covered291
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,498
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,498
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 1
Insurance contract or identification number1176
Number of Individuals Covered334
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $15,515
Total amount of fees paid to insurance companyUSD $16,260
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,515
Amount paid for insurance broker fees16260
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165521001
Policy instance 2
Insurance contract or identification number10165521001
Number of Individuals Covered259
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,122
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,122
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165531001
Policy instance 3
Insurance contract or identification number10165531001
Number of Individuals Covered82
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $441
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $441
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165541001
Policy instance 4
Insurance contract or identification number10165541001
Number of Individuals Covered278
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,637
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,637
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254071
Policy instance 5
Insurance contract or identification number10254071
Number of Individuals Covered107
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,254
Total amount of fees paid to insurance companyUSD $108
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,254
Amount paid for insurance broker fees108
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254073
Policy instance 6
Insurance contract or identification number10254073
Number of Individuals Covered94
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,624
Total amount of fees paid to insurance companyUSD $231
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $49,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,624
Amount paid for insurance broker fees231
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100025285
Policy instance 7
Insurance contract or identification number40000100025285
Number of Individuals Covered307
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,577
Total amount of fees paid to insurance companyUSD $254
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,577
Amount paid for insurance broker fees254
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number254435
Policy instance 8
Insurance contract or identification number254435
Number of Individuals Covered652
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $176,820
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $176,820
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 1
Insurance contract or identification number1176
Number of Individuals Covered366
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,189
Total amount of fees paid to insurance companyUSD $18,894
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,189
Amount paid for insurance broker fees18894
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP0000871309
Policy instance 2
Insurance contract or identification numberMP0000871309
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP0000871308
Policy instance 3
Insurance contract or identification numberMP0000871308
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberMP0000871303
Policy instance 4
Insurance contract or identification numberMP0000871303
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165521001
Policy instance 5
Insurance contract or identification number10165521001
Number of Individuals Covered278
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,691
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,691
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165531001
Policy instance 6
Insurance contract or identification number10165531001
Number of Individuals Covered81
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $511
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $511
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10165541001
Policy instance 7
Insurance contract or identification number10165541001
Number of Individuals Covered274
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,808
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,808
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254072
Policy instance 8
Insurance contract or identification number10254072
Number of Individuals Covered407
Insurance policy start date2019-07-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $856
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $11,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $856
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10254071
Policy instance 9
Insurance contract or identification number10254071
Number of Individuals Covered112
Insurance policy start date2019-07-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,622
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,622
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100025285
Policy instance 10
Insurance contract or identification number40000100025285
Number of Individuals Covered337
Insurance policy start date2019-07-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,538
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $25,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,538
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number173241
Policy instance 4
Insurance contract or identification number173241
Number of Individuals Covered690
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $154,206
Total amount of fees paid to insurance companyUSD $4,080
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $-4,214
Amount paid for insurance broker fees4080
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberF014879
Policy instance 3
Insurance contract or identification numberF014879
Number of Individuals Covered391
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $22,251
Total amount of fees paid to insurance companyUSD $9,730
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D; DEP
Welfare Benefit Premiums Paid to CarrierUSD $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 fees4468
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,878
Insurance broker nameGALLAGHER BENEFIT SERVICES
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 2
Insurance contract or identification number1176
Number of Individuals Covered374
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $10,727
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,727
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered366
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,933
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,211
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number875574G
Policy instance 3
Insurance contract or identification number875574G
Number of Individuals Covered336
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $18,542
Total amount of fees paid to insurance companyUSD $3,040
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D; WD-NST
Welfare Benefit Premiums Paid to CarrierUSD $123,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,542
Amount paid for insurance broker fees3040
Additional information about fees paid to insurance brokerBONUSES PAID
Insurance broker organization code?3
Insurance broker nameMASCHINO HUDELSON & ASSOCIATES
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 2
Insurance contract or identification number1176
Number of Individuals Covered334
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $9,608
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,608
Insurance broker organization code?3
Insurance broker nameNFP CORPORATE SERVICES, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered331
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,839
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,839
Insurance broker organization code?3
Insurance broker nameNFP CORPORATE SERVICES (OK) LLC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 4
Insurance contract or identification number1176
Number of Individuals Covered342
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,269
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,269
Insurance broker organization code?3
Insurance broker nameMASCHINO HUDELSON & ASSOCIATES
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016356-00
Policy instance 3
Insurance contract or identification number01-016356-00
Number of Individuals Covered143
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,468
Total amount of fees paid to insurance companyUSD $1,610
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1610
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,468
Insurance broker namePREMIER CONSULTING PARTNERS, LLC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016356-01
Policy instance 2
Insurance contract or identification number01-016356-01
Number of Individuals Covered213
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,151
Total amount of fees paid to insurance companyUSD $1,015
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1015
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $5,151
Insurance broker namePREMIER CONSULTING PARTNERS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered333
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,738
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,030
Insurance broker organization code?3
Insurance broker nameNFP CORPORATE SERVICES (OK) LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered252
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $1,472
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,472
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS, INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016356-00
Policy instance 2
Insurance contract or identification number01-016356-00
Number of Individuals Covered130
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,732
Total amount of fees paid to insurance companyUSD $877
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $57,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,732
Amount paid for insurance broker fees877
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-016356-01
Policy instance 3
Insurance contract or identification number01-016356-01
Number of Individuals Covered177
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,580
Total amount of fees paid to insurance companyUSD $1,091
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,580
Amount paid for insurance broker fees1091
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1176
Policy instance 4
Insurance contract or identification number1176
Number of Individuals Covered308
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,458
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,458
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered249
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $1,474
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,474
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS, INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0716410
Policy instance 2
Insurance contract or identification number0716410
Number of Individuals Covered386
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $119,033
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $119,033
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868539G
Policy instance 3
Insurance contract or identification number868539G
Number of Individuals Covered258
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,596
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $83,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,596
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05988300
Policy instance 4
Insurance contract or identification numberKM05988300
Number of Individuals Covered541
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,444
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,444
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered263
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,496
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,496
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS, INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8234
Policy instance 2
Insurance contract or identification number8234
Number of Individuals Covered240
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,008
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,008
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0716410
Policy instance 3
Insurance contract or identification number0716410
Number of Individuals Covered419
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $139,670
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $139,670
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868539G
Policy instance 4
Insurance contract or identification number868539G
Number of Individuals Covered258
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $9,019
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $90,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,019
Insurance broker organization code?3
Insurance broker nameSPIRIT INS AGENCY INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number868539G
Policy instance 5
Insurance contract or identification number868539G
Number of Individuals Covered244
Insurance policy start date2011-03-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,324
Total amount of fees paid to insurance companyUSD $2,836
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $78,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,324
Amount paid for insurance broker fees2836
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0716410
Policy instance 4
Insurance contract or identification number0716410
Number of Individuals Covered419
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $82,911
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $12,858
Insurance broker organization code?3
Insurance broker namePREMIER CONSULTING PARTNERS INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53935
Policy instance 3
Insurance contract or identification number53935
Number of Individuals Covered210
Insurance policy start date2009-02-01
Insurance policy end date2010-01-31
Total amount of commissions paid to insurance brokerUSD $8,385
Total amount of fees paid to insurance companyUSD $123
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 fees123
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $8,385
Insurance broker nameINSERVICES, INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8234
Policy instance 2
Insurance contract or identification number8234
Number of Individuals Covered252
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,109
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,218
Insurance broker organization code?3
Insurance broker nameINSERVICES INC DBA DILLINGHAM INS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered240
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $1,400
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
Insurance broker nameINSERVICES, INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered201
Insurance policy start date2008-04-01
Insurance policy end date2009-03-31
Total amount of commissions paid to insurance brokerUSD $1,265
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,031
Insurance broker organization code?3
Insurance broker nameINSERVICES, INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53935
Policy instance 3
Insurance contract or identification number53935
Number of Individuals Covered189
Insurance policy start date2008-02-01
Insurance policy end date2009-01-31
Total amount of commissions paid to insurance brokerUSD $9,360
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $124,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,526
Insurance broker organization code?3
Insurance broker nameINSERVICES, INC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8234
Policy instance 2
Insurance contract or identification number8234
Number of Individuals Covered217
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $4,622
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,622
Insurance broker organization code?3
Insurance broker nameSPIRIT INSURANCE AGENCY INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0716410
Policy instance 4
Insurance contract or identification number0716410
Number of Individuals Covered377
Insurance policy start date2009-02-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $61,902
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $61,902
Insurance broker organization code?3
Insurance broker nameINSERVICES INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered174
Insurance policy start date2007-04-01
Insurance policy end date2008-03-31
Total amount of commissions paid to insurance brokerUSD $1,028
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,028
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8234
Policy instance 2
Insurance contract or identification number8234
Number of Individuals Covered185
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $5,173
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,173
Insurance broker organization code?3
Insurance broker nameINSERVICES INC DBA BILLINGHAM INS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number53935
Policy instance 3
Insurance contract or identification number53935
Number of Individuals Covered45
Insurance policy start date2007-04-01
Insurance policy end date2008-01-31
Total amount of commissions paid to insurance brokerUSD $1,769
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,769
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number8234
Policy instance 2
Insurance contract or identification number8234
Number of Individuals Covered104
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $3,229
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,229
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )
Policy contract number12237020
Policy instance 1
Insurance contract or identification number12237020
Number of Individuals Covered97
Insurance policy start date2006-04-01
Insurance policy end date2007-03-31
Total amount of commissions paid to insurance brokerUSD $773
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $625
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC

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