NORTHERN MONTANA HOSPITAL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NORTHERN MONTANA HOSPITAL HEALTH PLAN
Measure | Date | Value |
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2022: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 375 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 370 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 370 |
2021: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 165 |
Total of all active and inactive participants | 2021-01-01 | 165 |
2020: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 204 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 189 |
Total of all active and inactive participants | 2020-01-01 | 189 |
2019: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 207 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 202 |
Total of all active and inactive participants | 2019-01-01 | 202 |
2018: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 251 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 209 |
Total of all active and inactive participants | 2018-01-01 | 209 |
2017: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 220 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 208 |
Total of all active and inactive participants | 2017-01-01 | 208 |
2016: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 209 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 203 |
Total of all active and inactive participants | 2016-01-01 | 203 |
2015: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 245 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 213 |
Total of all active and inactive participants | 2015-01-01 | 213 |
2014: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 264 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 237 |
Total of all active and inactive participants | 2014-01-01 | 237 |
2013: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 252 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 250 |
Total of all active and inactive participants | 2013-01-01 | 250 |
2012: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 222 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 236 |
Total of all active and inactive participants | 2012-01-01 | 236 |
2011: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 221 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 209 |
Total of all active and inactive participants | 2011-01-01 | 209 |
2009: NORTHERN MONTANA HOSPITAL HEALTH PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 238 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 229 |
Total of all active and inactive participants | 2009-01-01 | 229 |
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 ) |
Policy contract number | 06172 |
Policy instance | 5 |
Insurance contract or identification number | 06172 | Number of Individuals Covered | 288 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $10,060 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Dental Insurance Welfare Benefit | Yes | 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 $100,600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,060 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0BXTP |
Policy instance | 4 |
Insurance contract or identification number | GVTL0BXTP | Number of Individuals Covered | 63 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,291 | Total amount of fees paid to insurance company | USD $899 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D VOLUNTARY | 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 $28,609 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,291 | Amount paid for insurance broker fees | 899 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BXTP |
Policy instance | 3 |
Insurance contract or identification number | GLUG0BXTP | Number of Individuals Covered | 370 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,106 | Total amount of fees paid to insurance company | USD $1,955 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 $52,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,106 | Amount paid for insurance broker fees | 1955 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0BXTP |
Policy instance | 2 |
Insurance contract or identification number | GLTD0BXTP | Number of Individuals Covered | 370 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,899 | Total amount of fees paid to insurance company | USD $3,103 | 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 | 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 | Yes | 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 $82,901 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,899 | Amount paid for insurance broker fees | 3103 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 287 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | 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 $2,264,362 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 276 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,337,442 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908301 |
Policy instance | 2 |
Insurance contract or identification number | 908301 | Number of Individuals Covered | 416 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-09-01 | Total amount of commissions paid to insurance broker | USD $5,778 | Total amount of fees paid to insurance company | USD $663 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $88,412 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,778 | Amount paid for insurance broker fees | 663 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0BXTP |
Policy instance | 3 |
Insurance contract or identification number | GLTD0BXTP | Number of Individuals Covered | 365 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-01-01 | Total amount of commissions paid to insurance broker | USD $2,669 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,689 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,669 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BXTP |
Policy instance | 4 |
Insurance contract or identification number | GLUG0BXTP | Number of Individuals Covered | 365 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-01-01 | Total amount of commissions paid to insurance broker | USD $1,683 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $16,828 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,683 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0BXTP |
Policy instance | 5 |
Insurance contract or identification number | GVTL0BXTP | Number of Individuals Covered | 55 | Insurance policy start date | 2021-09-01 | Insurance policy end date | 2022-01-01 | Total amount of commissions paid to insurance broker | USD $1,198 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $7,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,198 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908302 |
Policy instance | 6 |
Insurance contract or identification number | 908302 | Number of Individuals Covered | 57 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-09-01 | Total amount of commissions paid to insurance broker | USD $2,459 | Total amount of fees paid to insurance company | USD $123 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $16,431 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,459 | Amount paid for insurance broker fees | 123 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908301 |
Policy instance | 3 |
Insurance contract or identification number | 908301 | Number of Individuals Covered | 419 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2021-01-01 | Total amount of commissions paid to insurance broker | USD $10,715 | Total amount of fees paid to insurance company | USD $1,493 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $183,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,715 | Amount paid for insurance broker fees | 1493 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908302 |
Policy instance | 2 |
Insurance contract or identification number | 908302 | Number of Individuals Covered | 64 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2021-01-01 | Total amount of commissions paid to insurance broker | USD $5,149 | Total amount of fees paid to insurance company | USD $258 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $31,128 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,149 | Amount paid for insurance broker fees | 258 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 299 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,613,505 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908302 |
Policy instance | 2 |
Insurance contract or identification number | 908302 | Number of Individuals Covered | 67 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2020-01-01 | Total amount of commissions paid to insurance broker | USD $5,054 | Total amount of fees paid to insurance company | USD $253 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $34,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,054 | Amount paid for insurance broker fees | 253 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 337 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,813,311 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908301 |
Policy instance | 3 |
Insurance contract or identification number | 908301 | Number of Individuals Covered | 437 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $8,731 | Total amount of fees paid to insurance company | USD $1,335 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $178,826 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,731 | Amount paid for insurance broker fees | 1335 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908302 |
Policy instance | 3 |
Insurance contract or identification number | 908302 | Number of Individuals Covered | 71 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2019-01-01 | Total amount of commissions paid to insurance broker | USD $5,341 | Total amount of fees paid to insurance company | USD $124 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $38,385 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,857 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 124 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908301 |
Policy instance | 2 |
Insurance contract or identification number | 908301 | Number of Individuals Covered | 436 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2019-01-01 | Total amount of commissions paid to insurance broker | USD $8,596 | Total amount of fees paid to insurance company | USD $604 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $179,550 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,145 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 604 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 349 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,110,273 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,500 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908302 |
Policy instance | 3 |
Insurance contract or identification number | 908302 | Number of Individuals Covered | 88 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2018-01-01 | Total amount of commissions paid to insurance broker | USD $6,552 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $43,683 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,552 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 908301 |
Policy instance | 2 |
Insurance contract or identification number | 908301 | Number of Individuals Covered | 471 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2018-01-01 | Total amount of commissions paid to insurance broker | USD $8,590 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $163,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,590 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 357 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,337,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 373 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $32,500 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,079,176 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,500 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 668960 |
Policy instance | 2 |
Insurance contract or identification number | GL 668960 | Number of Individuals Covered | 415 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $3,851 | Total amount of fees paid to insurance company | USD $6,932 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | DEPENDENT/SUPPLEMENTAL/AD&D | Welfare Benefit Premiums Paid to Carrier | USD $71,715 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,851 | Amount paid for insurance broker fees | 6932 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 672930 |
Policy instance | 3 |
Insurance contract or identification number | VAR 672930 | Number of Individuals Covered | 110 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $187 | Total amount of fees paid to insurance company | USD $337 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $3,464 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $187 | Amount paid for insurance broker fees | 337 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 669915 |
Policy instance | 4 |
Insurance contract or identification number | LTD 669915 | Number of Individuals Covered | 415 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $7,658 | Total amount of fees paid to insurance company | USD $13,784 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $142,326 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,658 | Amount paid for insurance broker fees | 13784 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | G 670396 |
Policy instance | 5 |
Insurance contract or identification number | G 670396 | Number of Individuals Covered | 1 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $54 | Total amount of fees paid to insurance company | USD $37 | Other welfare benefits provided | SHORT TERM DISABILITY | Welfare Benefit Premiums Paid to Carrier | USD $1,006 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54 | Amount paid for insurance broker fees | 37 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES INC |
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BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
Policy contract number | 12A263 |
Policy instance | 1 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 179 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $30,000 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,076,831 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,000 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 669915 |
Policy instance | 4 |
Insurance contract or identification number | LTD 669915 | Number of Individuals Covered | 409 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $5,889 | Total amount of fees paid to insurance company | USD $10,601 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,789 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,889 | Amount paid for insurance broker fees | 10601 | Additional information about fees paid to insurance broker | ADMINSTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE POINT LLC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 672930 |
Policy instance | 3 |
Insurance contract or identification number | VAR 672930 | Number of Individuals Covered | 113 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $112 | Total amount of fees paid to insurance company | USD $202 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,244 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $112 | Amount paid for insurance broker fees | 202 | Additional information about fees paid to insurance broker | ADMINSTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE POINT LLC |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 668960 |
Policy instance | 2 |
Insurance contract or identification number | GL 668960 | Number of Individuals Covered | 419 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $3,106 | Total amount of fees paid to insurance company | USD $5,591 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | DEPENDENT/SUPPLEMENTAL/AD&D | Welfare Benefit Premiums Paid to Carrier | USD $62,120 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,106 | Amount paid for insurance broker fees | 5591 | Additional information about fees paid to insurance broker | ADMINSTRATIVE AND OTHER | Insurance broker organization code? | 3 | Insurance broker name | INSURANCE POINT LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 119408 |
Policy instance | 1 |
Insurance contract or identification number | 119408 | Number of Individuals Covered | 435 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $9,462 | Total amount of fees paid to insurance company | USD $2,973 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $237,878 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,462 | Insurance broker organization code? | 5 | Amount paid for insurance broker fees | 2973 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | PEAK1 ADMINISTRATION LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 1190409 |
Policy instance | 2 |
Insurance contract or identification number | 1190409 | Number of Individuals Covered | 101 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $6,611 | Total amount of fees paid to insurance company | USD $551 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D | Welfare Benefit Premiums Paid to Carrier | USD $41,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,611 | Amount paid for insurance broker fees | 109 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 5 | Insurance broker name | PEAK1 ADMINISTRATION LLC |
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BLUE CROSS BLUE SHIELD OF MONTANA (National Association of Insurance Commissioners NAIC id number: 53686 ) |
Policy contract number | 12A263 |
Policy instance | 3 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 252 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $27,500 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,500 | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 1190409 |
Policy instance | 2 |
Insurance contract or identification number | 1190409 | Number of Individuals Covered | 106 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $4,542 | Total amount of fees paid to insurance company | USD $379 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D | Welfare Benefit Premiums Paid to Carrier | USD $35,837 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,542 | Amount paid for insurance broker fees | 379 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 5 | Insurance broker name | PEAK1 ADMINISTRATION LLC |
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BLUE CROSS BLUE SHIELD OF MONTANA (National Association of Insurance Commissioners NAIC id number: 53686 ) |
Policy contract number | 12A263 |
Policy instance | 3 |
Insurance contract or identification number | 12A263 | Number of Individuals Covered | 240 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | STEVEN MARIANI |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 119408 |
Policy instance | 1 |
Insurance contract or identification number | 119408 | Number of Individuals Covered | 420 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $8,435 | Total amount of fees paid to insurance company | USD $2,023 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $213,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,435 | Amount paid for insurance broker fees | 2023 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 5 | Insurance broker name | PEAK1 ADMINISTRATION LLC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 119408 |
Policy instance | 2 |
Insurance contract or identification number | 119408 | Number of Individuals Covered | 434 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $9,039 | Total amount of fees paid to insurance company | USD $2,089 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $208,867 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NEW WEST HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 95829 ) |
Policy contract number | N000561 |
Policy instance | 1 |
Insurance contract or identification number | N000561 | Number of Individuals Covered | 413 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $25,613 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,012,061 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NEW WEST HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 95829 ) |
Policy contract number | N000561 |
Policy instance | 1 |
Insurance contract or identification number | N000561 | Number of Individuals Covered | 420 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $24,363 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,918,939 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 119408 |
Policy instance | 2 |
Insurance contract or identification number | 119408 | Number of Individuals Covered | 443 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $9,032 | Total amount of fees paid to insurance company | USD $2,082 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $208,205 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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