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INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 401k Plan overview

Plan NameINDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN
Plan identification number 501

INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name:INDEPENDENT OPPORTUNITIES, INC.
Employer identification number (EIN):742547238
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01
5012021-04-01
5012020-04-01
5012019-04-01
5012018-04-01
5012017-04-01KEVIN IKENBERRY KEVIN IKENBERRY2018-10-19
5012016-04-01KEVIN IKENBERRY KEVIN IKENBERRY2017-10-19
5012015-04-01KEVIN IKENBERRY KEVIN IKENBERRY2016-10-28
5012014-04-01KEVIN IKENBERRY KEVIN IKENBERRY2015-09-10
5012013-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012012-04-01KEVIN IKENBERRY
5012011-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012009-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012008-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012007-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012006-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012005-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-10-30
5012004-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-09-25
5012003-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-09-25
5012002-04-01KEVIN IKENBERRY KEVIN IKENBERRY2014-09-25

Plan Statistics for INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN

401k plan membership statisitcs for INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN

Measure Date Value
2022: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01180
Total number of active participants reported on line 7a of the Form 55002022-04-01165
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01165
Total participants2022-04-01165
2021: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01209
Total number of active participants reported on line 7a of the Form 55002021-04-01175
Number of retired or separated participants receiving benefits2021-04-011
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01176
Total participants2021-04-01176
2020: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01231
Total number of active participants reported on line 7a of the Form 55002020-04-01211
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01211
Total participants2020-04-01211
2019: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01223
Total number of active participants reported on line 7a of the Form 55002019-04-01221
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01221
Total participants2019-04-01221
2018: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01239
Total number of active participants reported on line 7a of the Form 55002018-04-01210
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-04-010
Total participants2018-04-01210
Number of participants with account balances2018-04-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-04-010
2017: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01277
Total number of active participants reported on line 7a of the Form 55002017-04-01216
Number of retired or separated participants receiving benefits2017-04-012
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-04-010
Total participants2017-04-01218
Number of participants with account balances2017-04-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-04-010
2016: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01312
Total number of active participants reported on line 7a of the Form 55002016-04-01261
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01261
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-04-010
Total participants2016-04-01261
Number of participants with account balances2016-04-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-04-010
2015: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01287
Total number of active participants reported on line 7a of the Form 55002015-04-01269
Total of all active and inactive participants2015-04-01269
Total participants2015-04-01269
2014: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01279
Total number of active participants reported on line 7a of the Form 55002014-04-01246
Number of retired or separated participants receiving benefits2014-04-011
Total of all active and inactive participants2014-04-01247
Total participants2014-04-01247
2013: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01259
Total number of active participants reported on line 7a of the Form 55002013-04-01251
Number of retired or separated participants receiving benefits2013-04-011
Total of all active and inactive participants2013-04-01252
Total participants2013-04-01252
2012: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01249
Total number of active participants reported on line 7a of the Form 55002012-04-01232
Number of retired or separated participants receiving benefits2012-04-011
Total of all active and inactive participants2012-04-01233
Total participants2012-04-01233
2011: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01255
Total number of active participants reported on line 7a of the Form 55002011-04-01241
Number of retired or separated participants receiving benefits2011-04-011
Total of all active and inactive participants2011-04-01242
Total participants2011-04-01242
2009: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01282
Total number of active participants reported on line 7a of the Form 55002009-04-01250
Number of retired or separated participants receiving benefits2009-04-014
Total of all active and inactive participants2009-04-01254
Total participants2009-04-01254
2008: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2008 401k membership
Total participants, beginning-of-year2008-04-01294
Total number of active participants reported on line 7a of the Form 55002008-04-01268
Number of retired or separated participants receiving benefits2008-04-011
Total of all active and inactive participants2008-04-01269
Total participants2008-04-01269
2007: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2007 401k membership
Total participants, beginning-of-year2007-04-01347
Total number of active participants reported on line 7a of the Form 55002007-04-01282
Number of retired or separated participants receiving benefits2007-04-011
Total of all active and inactive participants2007-04-01283
Total participants2007-04-01283
2006: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2006 401k membership
Total participants, beginning-of-year2006-04-01379
Total number of active participants reported on line 7a of the Form 55002006-04-01326
Total of all active and inactive participants2006-04-01326
Total participants2006-04-01326
2005: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2005 401k membership
Total participants, beginning-of-year2005-04-01318
Total number of active participants reported on line 7a of the Form 55002005-04-01344
Total of all active and inactive participants2005-04-01344
Total participants2005-04-01344
2004: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2004 401k membership
Total participants, beginning-of-year2004-04-01300
Total number of active participants reported on line 7a of the Form 55002004-04-01276
Total of all active and inactive participants2004-04-01276
Total participants2004-04-01276
2003: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2003 401k membership
Total participants, beginning-of-year2003-04-01369
Total number of active participants reported on line 7a of the Form 55002003-04-01276
Total of all active and inactive participants2003-04-01276
Total participants2003-04-01276
2002: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2002 401k membership
Total participants, beginning-of-year2002-04-01318
Total number of active participants reported on line 7a of the Form 55002002-04-01301
Number of retired or separated participants receiving benefits2002-04-010
Number of other retired or separated participants entitled to future benefits2002-04-010
Total of all active and inactive participants2002-04-01301
Total participants2002-04-01301

Form 5500 Responses for INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN

2022: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes
2008: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2008 form 5500 responses
2008-04-01Type of plan entitySingle employer plan
2008-04-01Submission has been amendedNo
2008-04-01This submission is the final filingNo
2008-04-01This return/report is a short plan year return/report (less than 12 months)No
2008-04-01Plan is a collectively bargained planNo
2008-04-01Plan funding arrangement – InsuranceYes
2008-04-01Plan funding arrangement – General assets of the sponsorYes
2008-04-01Plan benefit arrangement – InsuranceYes
2008-04-01Plan benefit arrangement – General assets of the sponsorYes
2007: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2007 form 5500 responses
2007-04-01Type of plan entitySingle employer plan
2007-04-01Submission has been amendedNo
2007-04-01This submission is the final filingNo
2007-04-01This return/report is a short plan year return/report (less than 12 months)No
2007-04-01Plan is a collectively bargained planNo
2007-04-01Plan funding arrangement – InsuranceYes
2007-04-01Plan funding arrangement – General assets of the sponsorYes
2007-04-01Plan benefit arrangement – InsuranceYes
2007-04-01Plan benefit arrangement – General assets of the sponsorYes
2006: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2006 form 5500 responses
2006-04-01Type of plan entitySingle employer plan
2006-04-01Submission has been amendedNo
2006-04-01This submission is the final filingNo
2006-04-01This return/report is a short plan year return/report (less than 12 months)No
2006-04-01Plan is a collectively bargained planNo
2006-04-01Plan funding arrangement – InsuranceYes
2006-04-01Plan funding arrangement – General assets of the sponsorYes
2006-04-01Plan benefit arrangement – InsuranceYes
2006-04-01Plan benefit arrangement – General assets of the sponsorYes
2005: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2005 form 5500 responses
2005-04-01Type of plan entitySingle employer plan
2005-04-01Submission has been amendedNo
2005-04-01This submission is the final filingNo
2005-04-01This return/report is a short plan year return/report (less than 12 months)No
2005-04-01Plan is a collectively bargained planNo
2005-04-01Plan funding arrangement – InsuranceYes
2005-04-01Plan funding arrangement – General assets of the sponsorYes
2005-04-01Plan benefit arrangement – InsuranceYes
2005-04-01Plan benefit arrangement – General assets of the sponsorYes
2004: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2004 form 5500 responses
2004-04-01Type of plan entitySingle employer plan
2004-04-01Submission has been amendedNo
2004-04-01This submission is the final filingNo
2004-04-01This return/report is a short plan year return/report (less than 12 months)No
2004-04-01Plan is a collectively bargained planNo
2004-04-01Plan funding arrangement – InsuranceYes
2004-04-01Plan funding arrangement – General assets of the sponsorYes
2004-04-01Plan benefit arrangement – InsuranceYes
2004-04-01Plan benefit arrangement – General assets of the sponsorYes
2003: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2003 form 5500 responses
2003-04-01Type of plan entitySingle employer plan
2003-04-01Submission has been amendedNo
2003-04-01This submission is the final filingNo
2003-04-01This return/report is a short plan year return/report (less than 12 months)No
2003-04-01Plan is a collectively bargained planNo
2003-04-01Plan funding arrangement – InsuranceYes
2003-04-01Plan funding arrangement – General assets of the sponsorYes
2003-04-01Plan benefit arrangement – InsuranceYes
2003-04-01Plan benefit arrangement – General assets of the sponsorYes
2002: INDEPENDENT OPPORTUNITIES, INC. GROUP HEALTH PLAN 2002 form 5500 responses
2002-04-01Type of plan entitySingle employer plan
2002-04-01First time form 5500 has been submittedYes
2002-04-01Submission has been amendedNo
2002-04-01This submission is the final filingNo
2002-04-01This return/report is a short plan year return/report (less than 12 months)No
2002-04-01Plan is a collectively bargained planNo
2002-04-01Plan funding arrangement – InsuranceYes
2002-04-01Plan funding arrangement – General assets of the sponsorYes
2002-04-01Plan benefit arrangement – InsuranceYes
2002-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number914188
Policy instance 1
Insurance contract or identification number914188
Number of Individuals Covered171
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of fees paid to insurance companyUSD $80,564
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,899,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees80564
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0914188
Policy instance 1
Insurance contract or identification number0914188
Number of Individuals Covered175
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $78,875
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,914,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees78875
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0914188
Policy instance 1
Insurance contract or identification number0914188
Number of Individuals Covered211
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $93,821
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,385,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees93821
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0914188
Policy instance 1
Insurance contract or identification number0914188
Number of Individuals Covered221
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $15,265
Total amount of fees paid to insurance companyUSD $86,892
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,180,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $15,265
Amount paid for insurance broker fees86892
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0914188
Policy instance 1
Insurance contract or identification number0914188
Number of Individuals Covered210
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $79,682
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,770,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees79682
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0284084-MEDICAL
Policy instance 1
Insurance contract or identification number0284084-MEDICAL
Number of Individuals Covered218
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $58,677
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,276,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,677
Insurance broker organization code?3
Insurance broker nameINTERNATIONAL INSURANCE BROKERS LTD
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754148
Policy instance 1
Insurance contract or identification number754148
Number of Individuals Covered292
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $103,652
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,940,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees103652
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT AND BONUS
Insurance broker organization code?3
Insurance broker nameINTERNATIONAL INSURANCE BROKERS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754148
Policy instance 1
Insurance contract or identification number754148
Number of Individuals Covered278
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of fees paid to insurance companyUSD $91,949
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,748,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees91949
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameINTERNATIONAL INSURANCE BROKERS LTD
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number754148
Policy instance 1
Insurance contract or identification number754148
Number of Individuals Covered295
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of fees paid to insurance companyUSD $65,954
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,148,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees65954
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameINTERNATIONAL INSURANCE BROKERS
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered265
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $55,571
Total amount of fees paid to insurance companyUSD $1,220
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,111,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,571
Amount paid for insurance broker fees1220
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
Insurance broker nameINTERNATIONAL INSURANCE BROKER, LTD
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered297
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $54,988
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,099,765
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 numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered288
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $50,935
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,023,639
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 numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered303
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $48,847
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $985,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,767
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered369
Insurance policy start date2008-04-01
Insurance policy end date2009-03-31
Total amount of commissions paid to insurance brokerUSD $40,501
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $869,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,501
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberY05472
Policy instance 1
Insurance contract or identification numberY05472
Number of Individuals Covered369
Insurance policy start date2007-04-01
Insurance policy end date2008-03-31
Total amount of commissions paid to insurance brokerUSD $23,248
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $770,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,266
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number5472-00, -10
Policy instance 1
Insurance contract or identification number5472-00, -10
Number of Individuals Covered323
Insurance policy start date2006-04-01
Insurance policy end date2007-03-31
Total amount of commissions paid to insurance brokerUSD $23,266
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,266
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number5472-00, -10
Policy instance 1
Insurance contract or identification number5472-00, -10
Number of Individuals Covered336
Insurance policy start date2005-04-01
Insurance policy end date2006-03-31
Total amount of commissions paid to insurance brokerUSD $21,497
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,497
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number5472-00, -10
Policy instance 1
Insurance contract or identification number5472-00, -10
Number of Individuals Covered265
Insurance policy start date2004-04-01
Insurance policy end date2005-03-31
Total amount of commissions paid to insurance brokerUSD $19,923
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,923
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION
BLUECROSS BLUESHIELD OF OKLAHOMA (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number5472-00, -10
Policy instance 1
Insurance contract or identification number5472-00, -10
Number of Individuals Covered301
Insurance policy start date2002-04-01
Insurance policy end date2003-03-31
Total amount of commissions paid to insurance brokerUSD $23,601
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,601
Insurance broker organization code?3
Insurance broker nameTHE HOLMES ORGANIZATION

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