VALLEY VISTA CARE CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN
401k plan membership statisitcs for VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 130 |
| 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 | 130 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 307 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 167 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 167 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 381 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 307 |
| Total of all active and inactive participants | 2020-01-01 | 307 |
| Total participants | 2020-01-01 | 307 |
| 2019: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 392 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 381 |
| Total of all active and inactive participants | 2019-01-01 | 381 |
| Total participants | 2019-01-01 | 381 |
| 2018: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 373 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 392 |
| Total of all active and inactive participants | 2018-01-01 | 392 |
| Total participants | 2018-01-01 | 392 |
| 2017: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 350 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 373 |
| Total of all active and inactive participants | 2017-01-01 | 373 |
| Total participants | 2017-01-01 | 373 |
| 2016: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 350 |
| Total of all active and inactive participants | 2016-01-01 | 350 |
| Total participants | 2016-01-01 | 350 |
| 2015: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 377 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 339 |
| Total of all active and inactive participants | 2015-01-01 | 339 |
| Total participants | 2015-01-01 | 0 |
| 2014: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 331 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 377 |
| Total of all active and inactive participants | 2014-01-01 | 377 |
| Total participants | 2014-01-01 | 0 |
| 2013: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 380 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 331 |
| Total of all active and inactive participants | 2013-01-01 | 331 |
| Total participants | 2013-01-01 | 0 |
| 2011: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 392 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 390 |
| Total of all active and inactive participants | 2011-01-01 | 390 |
| Total participants | 2011-01-01 | 390 |
| 2009: VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 422 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 425 |
| Total of all active and inactive participants | 2009-01-01 | 425 |
| Total participants | 2009-01-01 | 425 |
| Measure | Date | Value |
|---|
| 2020 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $2,003,004 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $2,003,004 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $1,669,078 |
| Total contributions received or receivable from participants | 2020-12-31 | $511,716 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $333,926 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $1,491,288 |
| 2019 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $2,249,944 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $2,249,944 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $1,900,592 |
| Total contributions received or receivable from participants | 2019-12-31 | $541,853 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $349,352 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $1,708,091 |
| 2018 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $2,251,558 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $2,251,558 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $1,923,918 |
| Total contributions received or receivable from participants | 2018-12-31 | $499,795 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $327,640 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $1,751,763 |
| 2017 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $2,008,018 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $2,008,018 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $1,638,964 |
| Total contributions received or receivable from participants | 2017-12-31 | $504,392 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $369,054 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $1,503,626 |
| 2016 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $1,808,162 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,808,162 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $1,377,781 |
| Total contributions received or receivable from participants | 2016-12-31 | $422,750 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $430,381 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $1,385,412 |
| 2015 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $1,837,542 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,837,542 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $1,333,343 |
| Total contributions received or receivable from participants | 2015-12-31 | $416,701 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $504,199 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $1,420,841 |
| 2014 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $1,535,314 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,535,314 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,095,439 |
| Total contributions received or receivable from participants | 2014-12-31 | $372,850 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $439,875 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,162,464 |
| 2013 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $1,262,845 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $1,262,845 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $922,759 |
| Total contributions received or receivable from participants | 2013-12-31 | $282,975 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $340,086 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $979,870 |
| 2011 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $943,737 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $943,737 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $661,649 |
| Total contributions received or receivable from participants | 2011-12-31 | $236,500 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $282,088 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $707,237 |
| 2010 : VALLEY VISTA CARE CORPORATION EMPLOYEE BENEFIT PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $1,054,493 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $1,054,493 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $810,502 |
| Total contributions received or receivable from participants | 2010-12-31 | $228,719 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $243,991 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $825,774 |
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GL-3447 |
| Policy instance | 2 |
| Insurance contract or identification number | GL-3447 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $9,998 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT,CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $73,711 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,998 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 ) |
| Policy contract number | ID380 |
| Policy instance | 1 |
| Insurance contract or identification number | ID380 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $725 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $725 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GL-3447 |
| Policy instance | 2 |
| Insurance contract or identification number | GL-3447 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $10,434 | | Total amount of fees paid to insurance company | USD $0 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT,CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $77,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,434 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 ) |
| Policy contract number | ID380 |
| Policy instance | 1 |
| Insurance contract or identification number | ID380 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,259 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,259 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) |
| Policy contract number | 1427 |
| Policy instance | 1 |
| Insurance contract or identification number | 1427 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,803 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,803 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G6-3447A |
| Policy instance | 2 |
| Insurance contract or identification number | G6-3447A | | Number of Individuals Covered | 37 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,693 | | Other welfare benefits provided | ACCIDENT INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $17,956 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,693 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 ) |
| Policy contract number | 10033099 |
| Policy instance | 3 |
| Insurance contract or identification number | 10033099 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $39,690 | | Total amount of fees paid to insurance company | USD $5,160 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,776,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,690 | | Amount paid for insurance broker fees | 5160 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 ) |
| Policy contract number | ID380 |
| Policy instance | 4 |
| Insurance contract or identification number | ID380 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,669 | | Total amount of fees paid to insurance company | USD $6,119 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,669 | | Amount paid for insurance broker fees | 6119 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE FEE | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G7-3447A |
| Policy instance | 5 |
| Insurance contract or identification number | G7-3447A | | Number of Individuals Covered | 36 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,508 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $10,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,508 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GL-3447 |
| Policy instance | 6 |
| Insurance contract or identification number | GL-3447 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $520 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $520 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GD-3447 |
| Policy instance | 7 |
| Insurance contract or identification number | GD-3447 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $484 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,783 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $484 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GS-3447A |
| Policy instance | 8 |
| Insurance contract or identification number | GS-3447A | | Number of Individuals Covered | 51 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,409 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $22,728 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,409 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G2-3447A |
| Policy instance | 9 |
| Insurance contract or identification number | G2-3447A | | Number of Individuals Covered | 115 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,835 | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $18,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,835 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GD-3447A |
| Policy instance | 10 |
| Insurance contract or identification number | GD-3447A | | Number of Individuals Covered | 42 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,480 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,480 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GD-3447 |
| Policy instance | 10 |
| Insurance contract or identification number | GD-3447 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $531 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $531 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G2-3447A |
| Policy instance | 9 |
| Insurance contract or identification number | G2-3447A | | Number of Individuals Covered | 136 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,861 | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $19,073 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,861 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GS-3447A |
| Policy instance | 8 |
| Insurance contract or identification number | GS-3447A | | Number of Individuals Covered | 42 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,654 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $17,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,654 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GD-3447(A) |
| Policy instance | 7 |
| Insurance contract or identification number | GD-3447(A) | | Number of Individuals Covered | 33 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,795 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,795 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) |
| Policy contract number | 1427 |
| Policy instance | 1 |
| Insurance contract or identification number | 1427 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,582 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,582 | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G6-3447A |
| Policy instance | 2 |
| Insurance contract or identification number | G6-3447A | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,489 | | Other welfare benefits provided | ACCIDENT INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $16,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,489 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 ) |
| Policy contract number | 10033099 |
| Policy instance | 3 |
| Insurance contract or identification number | 10033099 | | Number of Individuals Covered | 381 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $43,688 | | Total amount of fees paid to insurance company | USD $6,360 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,037,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,688 | | Amount paid for insurance broker fees | 6360 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 ) |
| Policy contract number | ID380 |
| Policy instance | 4 |
| Insurance contract or identification number | ID380 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,740 | | Total amount of fees paid to insurance company | USD $6,577 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,740 | | Amount paid for insurance broker fees | 6577 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE FEE | | Insurance broker organization code? | 3 |
|
| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G7-3447A |
| Policy instance | 5 |
| Insurance contract or identification number | G7-3447A | | Number of Individuals Covered | 30 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,193 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $7,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,193 | | Insurance broker organization code? | 3 |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GL-3447 |
| Policy instance | 6 |
| Insurance contract or identification number | GL-3447 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $552 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $552 | | Insurance broker organization code? | 3 |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G6-3447A |
| Policy instance | 2 |
| Insurance contract or identification number | G6-3447A | | Number of Individuals Covered | 43 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,236 | | Other welfare benefits provided | ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,236 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| BLUE CROSS OF IDAHO HEALTH SERVICE INC. (National Association of Insurance Commissioners NAIC id number: 60095 ) |
| Policy contract number | 10033099 |
| Policy instance | 3 |
| Insurance contract or identification number | 10033099 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $44,603 | | Total amount of fees paid to insurance company | USD $3,520 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,881,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,603 | | Amount paid for insurance broker fees | 3520 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 ) |
| Policy contract number | ID380 |
| Policy instance | 4 |
| Insurance contract or identification number | ID380 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,113 | | Total amount of fees paid to insurance company | USD $4,080 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,113 | | Amount paid for insurance broker fees | 4080 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | THE MURRAY GROUP, INC. |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G7-3447A |
| Policy instance | 5 |
| Insurance contract or identification number | G7-3447A | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,113 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $7,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,113 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GL-3447 |
| Policy instance | 6 |
| Insurance contract or identification number | GL-3447 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $505 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,703 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $505 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GD-3447, 3447A |
| Policy instance | 7 |
| Insurance contract or identification number | GD-3447, 3447A | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,238 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,238 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | GS-3447A |
| Policy instance | 8 |
| Insurance contract or identification number | GS-3447A | | Number of Individuals Covered | 54 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,804 | | Other welfare benefits provided | SHORT-TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $18,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,804 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| UNITED HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63983 ) |
| Policy contract number | G2-3447A |
| Policy instance | 9 |
| Insurance contract or identification number | G2-3447A | | Number of Individuals Covered | 208 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,517 | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $16,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,517 | | Insurance broker organization code? | 3 | | Insurance broker name | GREG HELBLING |
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| DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 ) |
| Policy contract number | 1427 |
| Policy instance | 1 |
| Insurance contract or identification number | 1427 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,966 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,966 | | Insurance broker organization code? | 3 | | Insurance broker name | THE MURRAY GROUP, INC. |
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