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STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 401k Plan overview

Plan NameSTAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN
Plan identification number 506

STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN Benefits

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

401k Sponsoring company profile

STAR-JOURNAL PUBLISHING CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:STAR-JOURNAL PUBLISHING CORPORATION
Employer identification number (EIN):840327390
NAIC Classification:511110
NAIC Description:Newspaper Publishers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062018-01-01
5062017-01-01JANE L RAWLINGS
5062016-01-01AMANDA TAULMAN JANE L. RAWLINGS2017-07-26
5062015-01-01AMANDA TAULMAN ROBERT H. RAWLINGS2016-09-14
5062014-01-01GREG WAGNER ROBERT H. RAWLINGS2015-10-14
5062013-01-01GREG WAGNER ROBERT H. RAWLINGS2014-09-26
5062012-01-01GREG WAGNER ROBERT H. RAWLINGS2013-10-08
5062011-01-01GREG WAGNER ROBERT H RAWLINGS2012-09-28
5062010-01-01TONA MCDOWELL ROBERT H RAWLINGS2011-09-26
5062009-01-01MARVIN E LAUT JR ROBERT H RAWLINGS2010-09-17

Plan Statistics for STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN

401k plan membership statisitcs for STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN

Measure Date Value
2018: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01135
Total number of active participants reported on line 7a of the Form 55002018-01-0178
Total of all active and inactive participants2018-01-0178
Total participants2018-01-0178
2017: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01205
Total number of active participants reported on line 7a of the Form 55002017-01-01135
Total of all active and inactive participants2017-01-01135
Total participants2017-01-01135
2016: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01155
Total number of active participants reported on line 7a of the Form 55002016-01-01205
Total of all active and inactive participants2016-01-01205
Total participants2016-01-01205
2015: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01169
Total number of active participants reported on line 7a of the Form 55002015-01-01155
Total of all active and inactive participants2015-01-01155
Total participants2015-01-010
2014: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01171
Total number of active participants reported on line 7a of the Form 55002014-01-01169
Total of all active and inactive participants2014-01-01169
Total participants2014-01-010
2013: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01206
Total number of active participants reported on line 7a of the Form 55002013-01-01171
Total of all active and inactive participants2013-01-01171
Total participants2013-01-010
2012: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01125
Total number of active participants reported on line 7a of the Form 55002012-01-01206
Total of all active and inactive participants2012-01-01206
Total participants2012-01-010
2011: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01125
Total number of active participants reported on line 7a of the Form 55002011-01-01127
Total of all active and inactive participants2011-01-01127
Total participants2011-01-01127
2010: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01130
Total number of active participants reported on line 7a of the Form 55002010-01-01125
Total of all active and inactive participants2010-01-01125
Total participants2010-01-01125
2009: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01159
Total number of active participants reported on line 7a of the Form 55002009-01-01130
Total of all active and inactive participants2009-01-01130
Total participants2009-01-01130

Form 5500 Responses for STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN

2018: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: STAR JOURNAL PUBLISHING DBA THE PUEBLO CHIEFTAIN HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5925647
Policy instance 4
Insurance contract or identification number5925647
Number of Individuals Covered39
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,180
Total amount of fees paid to insurance companyUSD $320
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $695
Insurance broker organization code?3
Amount paid for insurance broker fees118
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010186912
Policy instance 3
Insurance contract or identification number000010186912
Number of Individuals Covered52
Insurance policy start date2018-01-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $410
Total amount of fees paid to insurance companyUSD $103
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $410
Insurance broker organization code?3
Amount paid for insurance broker fees103
Additional information about fees paid to insurance brokerBROKER BONUS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037747
Policy instance 2
Insurance contract or identification number30037747
Number of Individuals Covered58
Insurance policy start date2018-01-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $475
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $475
Insurance broker organization code?3
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195986
Policy instance 1
Insurance contract or identification number195986
Number of Individuals Covered78
Insurance policy start date2018-01-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $17,340
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $438,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,464
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037747
Policy instance 2
Insurance contract or identification number30037747
Number of Individuals Covered69
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $781
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $781
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INSURANCE SVC INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010186912
Policy instance 3
Insurance contract or identification number000010186912
Number of Individuals Covered54
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $865
Total amount of fees paid to insurance companyUSD $215
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $688
Insurance broker organization code?3
Amount paid for insurance broker fees215
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameHUB INTERNATIONAL INS SVCS INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05925647
Policy instance 4
Insurance contract or identification numberTS05925647
Number of Individuals Covered48
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,399
Total amount of fees paid to insurance companyUSD $655
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,001
Amount paid for insurance broker fees80
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INS SERVICES INC
BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 )
Policy contract number1734000
Policy instance 5
Insurance contract or identification number1734000
Number of Individuals Covered44
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $902
Welfare Benefit Premiums Paid to CarrierUSD $9,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $902
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INSURANCE SVC INC
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195986
Policy instance 1
Insurance contract or identification number195986
Number of Individuals Covered135
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $37,738
Total amount of fees paid to insurance companyUSD $1,133
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $886,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,738
Insurance broker organization code?3
Amount paid for insurance broker fees1133
Additional information about fees paid to insurance brokerFEES
Insurance broker nameHUB INTERNATIONAL INSURANCE SVC INC
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195986
Policy instance 1
Insurance contract or identification number195986
Number of Individuals Covered155
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $39,925
Total amount of fees paid to insurance companyUSD $445
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $816,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,925
Amount paid for insurance broker fees274
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameINTERACTIVE INSURANCE SOLUTIONS INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037747
Policy instance 2
Insurance contract or identification number30037747
Number of Individuals Covered68
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $786
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $786
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010186912
Policy instance 3
Insurance contract or identification number000010186912
Number of Individuals Covered65
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $887
Total amount of fees paid to insurance companyUSD $145
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $887
Insurance broker organization code?3
Amount paid for insurance broker fees145
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker nameHUB INTERNATIONAL MIDWEST LTD
BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 )
Policy contract number1734000
Policy instance 4
Insurance contract or identification number1734000
Number of Individuals Covered49
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,116
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,116
Insurance broker nameHUB INTERNATIONAL INSURANCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037747
Policy instance 2
Insurance contract or identification number30037747
Number of Individuals Covered72
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $802
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $802
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL SERVICES, INC.
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195986
Policy instance 1
Insurance contract or identification number195986
Number of Individuals Covered169
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $44,021
Total amount of fees paid to insurance companyUSD $708
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $881,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,021
Amount paid for insurance broker fees708
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INSURANCE
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010186912
Policy instance 3
Insurance contract or identification number000010186912
Number of Individuals Covered73
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $817
Total amount of fees paid to insurance companyUSD $187
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $817
Amount paid for insurance broker fees187
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INS SVCS INC.
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195986
Policy instance 3
Insurance contract or identification number195986
Number of Individuals Covered171
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $34,545
Total amount of fees paid to insurance companyUSD $1,114
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $724,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,545
Amount paid for insurance broker fees1114
Additional information about fees paid to insurance brokerINCENTIVES,EDUCATION, COMMUNICATION AND TRAINING
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL SERVICES, INC.
BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 )
Policy contract number1734000
Policy instance 2
Insurance contract or identification number1734000
Number of Individuals Covered54
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,139
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $770
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INSURANCE
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number1110474376000
Policy instance 1
Insurance contract or identification number1110474376000
Number of Individuals Covered20
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,485
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,952
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL INS SVCS INC.
BETA HEALTH ASSOCIATION, INC. (National Association of Insurance Commissioners NAIC id number: 81300 )
Policy contract number1734000
Policy instance 1
Insurance contract or identification number1734000
Number of Individuals Covered50
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,219
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,219
Insurance broker organization code?3
Insurance broker nameD.B. GOLENDA INSURANCE INC.
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number49691
Policy instance 3
Insurance contract or identification number49691
Number of Individuals Covered206
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $32,817
Total amount of fees paid to insurance companyUSD $2,728
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $968,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,817
Amount paid for insurance broker fees2728
Additional information about fees paid to insurance brokerRETENTION
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number1110474376000
Policy instance 2
Insurance contract or identification number1110474376000
Number of Individuals Covered20
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,192
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,192
Insurance broker organization code?3
Insurance broker nameBETA HEALTH ASSOCIATES, INC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number358270
Policy instance 3
Insurance contract or identification number358270
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12231323
Policy instance 2
Insurance contract or identification number12231323
Number of Individuals Covered125
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $529
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number49691
Policy instance 1
Insurance contract or identification number49691
Number of Individuals Covered127
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $31,123
Total amount of fees paid to insurance companyUSD $13,205
Welfare Benefit Premiums Paid to CarrierUSD $1,247,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number358270
Policy instance 2
Insurance contract or identification number358270
Number of Individuals Covered125
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $31,854
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $325,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,854
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL SOUTHWEST AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12231323
Policy instance 1
Insurance contract or identification number12231323
Number of Individuals Covered129
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $537
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $537
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL SOUTHWEST AGENCY

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