MATRIX SERVICE COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MATRIX SERVICE COMPANY HEALTH BENEFIT PLAN
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 7 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 22 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $18,046 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,215 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,046 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 1 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 7 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $3,020 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $88,018 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,020 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691900 |
Policy instance | 2 |
Insurance contract or identification number | 021691900 | Number of Individuals Covered | 29 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $203,518 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 3 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 146 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $2,173 | Total amount of fees paid to insurance company | USD $517 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $27,996 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,173 | Amount paid for insurance broker fees | 131 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
Policy contract number | 4EL405520 |
Policy instance | 4 |
Insurance contract or identification number | 4EL405520 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $732 | Other welfare benefits provided | BUSINESS TRAVEL MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $732 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 5 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1046 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $5,569 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $232,666 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,569 | Insurance broker organization code? | 3 |
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NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 6 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 453 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $4,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) |
Policy contract number | 2116200 |
Policy instance | 16 |
Insurance contract or identification number | 2116200 | Number of Individuals Covered | 74 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $418,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 8 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 122 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $736,368 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 9 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 948 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of fees paid to insurance company | USD $4,529 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $287,383 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 4529 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 15 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 326 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of fees paid to insurance company | USD $2,990 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $179,039 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2990 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 14 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 3465 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of fees paid to insurance company | USD $9,136 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $571,725 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 9136 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | G9038 |
Policy instance | 13 |
Insurance contract or identification number | G9038 | Number of Individuals Covered | 83 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $95,790 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 12 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 2198 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of fees paid to insurance company | USD $2,647 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $165,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2647 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
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RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 11 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 576 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $62,246 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $232,744 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,246 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 10 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 10 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $133,362 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 7 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 3774 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $507,217 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 6 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 765 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $60,565 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $226,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $60,565 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 5 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 23 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $4,109 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $129,840 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,109 | Insurance broker organization code? | 3 |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 3 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 24 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $4 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $75,116 | 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 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691900 |
Policy instance | 2 |
Insurance contract or identification number | 021691900 | Number of Individuals Covered | 33 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $211,978 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 1 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 358 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $125,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) |
Policy contract number | 2116200 |
Policy instance | 8 |
Insurance contract or identification number | 2116200 | Number of Individuals Covered | 63 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $188,992 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 9 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 1005 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $258,646 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | G9038 |
Policy instance | 10 |
Insurance contract or identification number | G9038 | Number of Individuals Covered | 55 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $72,861 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 14 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 145 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $3,122 | Total amount of fees paid to insurance company | USD $681 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $39,467 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,122 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 538 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
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FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
Policy contract number | 4EL405520 |
Policy instance | 16 |
Insurance contract or identification number | 4EL405520 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Other welfare benefits provided | BUSINESS TRAVEL MEDICAL | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 15 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 136 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $549,850 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 4 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 2276 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $146,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 11 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 12 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,782 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 13 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1137 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $4,577 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $243,446 | 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 | Insurance broker organization code? | 3 |
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NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 12 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 595 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $4,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 10 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 325 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $217,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 9 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 146 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $3,884 | Total amount of fees paid to insurance company | USD $536 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $54,298 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,269 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 484 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
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NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 11 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 718 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $5,928 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | G8264 |
Policy instance | 14 |
Insurance contract or identification number | G8264 | Number of Individuals Covered | 70 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $111,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 12 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 374 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $159,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 13 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 148 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $884,020 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
Policy contract number | 4EL405520 |
Policy instance | 8 |
Insurance contract or identification number | 4EL405520 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $732 | Other welfare benefits provided | BUSINESS TRAVEL MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $732 | Insurance broker organization code? | 3 |
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RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 7 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 573 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $62,535 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $245,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,535 | Insurance broker organization code? | 3 |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 6 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 22 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $20,171 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $89,504 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,169 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 5 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 14 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $111,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 4 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1215 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $3,792 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $277,368 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,792 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 3 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 3189 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $693,895 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691900 |
Policy instance | 2 |
Insurance contract or identification number | 021691900 | Number of Individuals Covered | 36 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $280,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 1 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 1908 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $201,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) |
Policy contract number | 2116200 |
Policy instance | 15 |
Insurance contract or identification number | 2116200 | Number of Individuals Covered | 29 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $144,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 16 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 24 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $6,858 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $195,955 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,858 | Insurance broker organization code? | 3 |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 2 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 146 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $3,884 | Total amount of fees paid to insurance company | USD $536 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $54,298 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | G8264 |
Policy instance | 11 |
Insurance contract or identification number | G8264 | Number of Individuals Covered | 70 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $111,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 12 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1215 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $3,792 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $277,368 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 13 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 24 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $6,858 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $195,955 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) |
Policy contract number | 2116200 |
Policy instance | 14 |
Insurance contract or identification number | 2116200 | Number of Individuals Covered | 29 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $144,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 10 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 148 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $884,020 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 16 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 1908 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $201,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691900 |
Policy instance | 1 |
Insurance contract or identification number | 021691900 | Number of Individuals Covered | 36 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $280,695 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 15 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 718 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $5,928 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 9 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 573 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $62,535 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $245,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 8 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 14 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $111,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 7 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 374 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $159,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 6 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 325 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $217,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 5 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 22 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $20,171 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $89,504 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
Policy contract number | 4EL405520 |
Policy instance | 4 |
Insurance contract or identification number | 4EL405520 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $732 | Other welfare benefits provided | BUSINESS TRAVEL MEDICAL | Welfare Benefit Premiums Paid to Carrier | USD $4,883 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 4 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 201 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,173,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 12 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 20 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $145,415 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 11 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 3005 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of fees paid to insurance company | USD $3,312 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $238,167 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 3312 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 10 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 817 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $5,928 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 1 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 159 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $4,022 | Total amount of fees paid to insurance company | USD $677 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $37,371 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,022 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 446 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 2 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1461 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $5,306 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $331,409 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,306 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 3 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 31 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $5,903 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,903 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 5 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 1264 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of fees paid to insurance company | USD $3,657 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $264,687 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 3657 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 6 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 409 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of fees paid to insurance company | USD $2,612 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $192,793 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2612 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 7 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 761 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $1,567 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $271,062 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,567 | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 8 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 4587 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of fees paid to insurance company | USD $11,155 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $882,518 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 11155 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691300 |
Policy instance | 9 |
Insurance contract or identification number | 021691300 | Number of Individuals Covered | 54 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $388,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 12 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 643 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $4,948 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $284,438 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,948 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 11 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 28 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $163,758 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691300 |
Policy instance | 10 |
Insurance contract or identification number | 021691300 | Number of Individuals Covered | 31 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $228,748 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 1 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 2860 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of fees paid to insurance company | USD $3,444 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $211,219 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 3444 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 2 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 849 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $5,928 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 3 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 422 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of fees paid to insurance company | USD $2,679 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $161,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 2679 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 4 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 1425 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of fees paid to insurance company | USD $4,607 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $254,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 4607 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 5 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 242 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,142,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 6 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 33 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $6,106 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $227,144 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,106 | Insurance broker organization code? | 3 |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 7 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 165 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $3,584 | Total amount of fees paid to insurance company | USD $706 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $32,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,285 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 611 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 8 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 5469 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of fees paid to insurance company | USD $11,865 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $731,546 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 11865 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 9 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1574 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $5,287 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $323,870 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,287 | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 5 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 287 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,261,722 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VDT962348 |
Policy instance | 4 |
Insurance contract or identification number | VDT962348 | Number of Individuals Covered | 435 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of fees paid to insurance company | USD $5,675 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $139,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX967877 |
Policy instance | 3 |
Insurance contract or identification number | FLX967877 | Number of Individuals Covered | 3742 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of fees paid to insurance company | USD $25,301 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $615,174 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 2 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 139 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $3,216 | Total amount of fees paid to insurance company | USD $588 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $29,639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 965371 |
Policy instance | 1 |
Insurance contract or identification number | LK 965371 | Number of Individuals Covered | 1377 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of fees paid to insurance company | USD $11,922 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $288,685 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 6 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 933 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $7,076 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $271,921 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 7 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 959 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,713 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 8 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 37 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $206,201 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 12 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 3873 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $20,229 | Welfare Benefit Premiums Paid to Carrier | USD $1,011,454 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021691300 |
Policy instance | 13 |
Insurance contract or identification number | 021691300 | Number of Individuals Covered | 20 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $117,007 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 11 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 40 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $2,097 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $197,470 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12238158 |
Policy instance | 10 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1465 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $5,223 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $305,233 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 969371 |
Policy instance | 9 |
Insurance contract or identification number | OK 969371 | Number of Individuals Covered | 2749 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of fees paid to insurance company | USD $8,039 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $189,092 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 1 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 53 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $250,735 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 2 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 1016 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,782 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $296,266 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,782 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 3 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 386 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,617,671 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 5 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 159 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,652 | Total amount of fees paid to insurance company | USD $610 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $37,463 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,652 | Amount paid for insurance broker fees | 610 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 7 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 21 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $23,826 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,703 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,826 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON FINANCIAL ADVISORS LLC |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 8 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 561 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,694 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12238158 |
Policy instance | 9 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1433 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $5,081 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $302,200 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,081 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 6 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 3740 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $1,564 | Welfare Benefit Premiums Paid to Carrier | USD $1,001,545 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,564 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649733 |
Policy instance | 4 |
Insurance contract or identification number | 649733 | Number of Individuals Covered | 2317 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 10 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 26 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,073 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $170,326 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,073 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12238158 |
Policy instance | 3 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1594 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $5,278 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $310,313 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,278 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 1 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 63 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $290,043 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 2 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 4161 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $963,948 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 4 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 386 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,495,811 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 5 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 40 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $3,022 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $153,842 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,022 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 649733 |
Policy instance | 7 |
Insurance contract or identification number | 649733 | Number of Individuals Covered | 2761 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 8 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 608 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Other welfare benefits provided | AD&D AND PARALYSIS | Welfare Benefit Premiums Paid to Carrier | USD $8,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 9 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 181 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $3,560 | Total amount of fees paid to insurance company | USD $500 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $36,083 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,560 | Amount paid for insurance broker fees | 500 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 10 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 950 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $2,107 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CRITICAL ILLNESS AND ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $271,996 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,107 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 6 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 22 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $20,082 | Total amount of fees paid to insurance company | USD $419 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,082 | Amount paid for insurance broker fees | 419 | Additional information about fees paid to insurance broker | BROKER FEES | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON FINANCIAL ADVISORS LLC |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 137035 |
Policy instance | 5 |
Insurance contract or identification number | GL 137035 | Number of Individuals Covered | 2115 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $23,135 | Total amount of fees paid to insurance company | USD $800 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ADD | Welfare Benefit Premiums Paid to Carrier | USD $1,349,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,135 | Amount paid for insurance broker fees | 800 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
|
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
Policy contract number | 8768451 |
Policy instance | 4 |
Insurance contract or identification number | 8768451 | Number of Individuals Covered | 15 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $29,396 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,458 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,396 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON FINANCIAL ADVISORS LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 3 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 73 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $214,898 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 67978-0 |
Policy instance | 1 |
Insurance contract or identification number | 67978-0 | Number of Individuals Covered | 689 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $9,626 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $216,528 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,626 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12238158 |
Policy instance | 2 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1414 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $4,931 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $269,023 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,931 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 8 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 30 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $1,790 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $90,659 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,790 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 6 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 604 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 7 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 3617 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $945,953 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 9 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 143 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $3,249 | Total amount of fees paid to insurance company | USD $463 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $34,648 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,124 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 463 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker name | LOCKTON COMPANIES, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 10 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 363 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,189,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 2 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 3378 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $684,739 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker name | MERCER HEALTH & BENEFITS LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 600860 |
Policy instance | 3 |
Insurance contract or identification number | 600860 | Number of Individuals Covered | 48 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $157,838 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $-102 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 226560 |
Policy instance | 4 |
Insurance contract or identification number | 226560 | Number of Individuals Covered | 347 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,239,005 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | -58 | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 36348 |
Policy instance | 5 |
Insurance contract or identification number | 36348 | Number of Individuals Covered | 33 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,187 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,187 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
|
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 1500693 |
Policy instance | 6 |
Insurance contract or identification number | 1500693 | Number of Individuals Covered | 121 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,650 | Total amount of fees paid to insurance company | USD $265 | Other welfare benefits provided | LEGAL | Welfare Benefit Premiums Paid to Carrier | USD $26,968 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,650 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 26 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker name | LOCKTON COMPANIES, LLC |
|
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | GTP0009102601 |
Policy instance | 7 |
Insurance contract or identification number | GTP0009102601 | Number of Individuals Covered | 488 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,724 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 ) |
Policy contract number | 12238158 |
Policy instance | 8 |
Insurance contract or identification number | 12238158 | Number of Individuals Covered | 1291 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $5,566 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $250,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $989 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
Policy contract number | 02209 |
Policy instance | 1 |
Insurance contract or identification number | 02209 | Number of Individuals Covered | 321 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $34,460 | Health Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER | Welfare Benefit Premiums Paid to Carrier | USD $107,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,965 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES LLC |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 137035 |
Policy instance | 9 |
Insurance contract or identification number | GL 137035 | Number of Individuals Covered | 2128 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $34,021 | Total amount of fees paid to insurance company | USD $1,071 | 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 $1,188,888 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,021 | Amount paid for insurance broker fees | 1071 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 | Insurance broker name | MERCER HEALTH & BENEFITS, LLC |
|
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | YNS017 |
Policy instance | 1 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 2936 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $27,948 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $544,889 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | YNS017 |
Policy instance | 1 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 2806 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | STOP LOSS | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $336,384 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 ) |
Policy contract number | YNS017 |
Policy instance | 1 |
Insurance contract or identification number | YNS017 | Number of Individuals Covered | 2017 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2010-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $20,758 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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