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MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 401k Plan overview

Plan NameMEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN
Plan identification number 601

MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

MEDVED CHEVROLET, INC. has sponsored the creation of one or more 401k plans.

Company Name:MEDVED CHEVROLET, INC.
Employer identification number (EIN):840396195
NAIC Classification:441110
NAIC Description:New Car Dealers

Additional information about MEDVED CHEVROLET, INC.

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1942-07-22
Company Identification Number: 19871133829
Legal Registered Office Address: 14250 W. 67th Avenue

Arvada
United States of America (USA)
80004

More information about MEDVED CHEVROLET, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
6012020-09-01NATALIA OATES2022-01-10
6012020-09-01DEREK SLEMKO2022-11-15
6012019-09-01KEVIN KUTSCHINSKI2021-03-18
6012018-09-01
6012017-09-01JOHN F MEDVED
6012016-09-01JOHN F MEDVED
6012014-09-01JOHN F MEDVED
6012013-09-01JOHN F MEDVED
6012012-09-01JOHN F MEDVED
6012011-09-01JOHN F MEDVED
6012010-09-01JOHN F MEDVED
6012009-09-01JOHN F MEDVED

Plan Statistics for MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN

401k plan membership statisitcs for MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN

Measure Date Value
2020: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01225
Total number of active participants reported on line 7a of the Form 55002020-09-01216
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01216
Number of employers contributing to the scheme2020-09-010
2019: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01271
Total number of active participants reported on line 7a of the Form 55002019-09-01225
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01225
Number of employers contributing to the scheme2019-09-010
2018: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01301
Total number of active participants reported on line 7a of the Form 55002018-09-01265
Number of retired or separated participants receiving benefits2018-09-016
Total of all active and inactive participants2018-09-01271
Total participants2018-09-01271
2017: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01330
Total number of active participants reported on line 7a of the Form 55002017-09-01296
Number of retired or separated participants receiving benefits2017-09-015
Total of all active and inactive participants2017-09-01301
Total participants2017-09-01301
2016: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01300
Total number of active participants reported on line 7a of the Form 55002016-09-01322
Number of retired or separated participants receiving benefits2016-09-012
Number of other retired or separated participants entitled to future benefits2016-09-016
Total of all active and inactive participants2016-09-01330
Total participants2016-09-01330
2014: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01227
Total number of active participants reported on line 7a of the Form 55002014-09-01265
Number of other retired or separated participants entitled to future benefits2014-09-013
Total of all active and inactive participants2014-09-01268
Total participants2014-09-010
2013: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01193
Total number of active participants reported on line 7a of the Form 55002013-09-01183
Number of retired or separated participants receiving benefits2013-09-012
Number of other retired or separated participants entitled to future benefits2013-09-011
Total of all active and inactive participants2013-09-01186
Total participants2013-09-010
2012: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01154
Total number of active participants reported on line 7a of the Form 55002012-09-01183
Number of retired or separated participants receiving benefits2012-09-012
Number of other retired or separated participants entitled to future benefits2012-09-018
Total of all active and inactive participants2012-09-01193
Total participants2012-09-010
2011: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01153
Total number of active participants reported on line 7a of the Form 55002011-09-01145
Number of retired or separated participants receiving benefits2011-09-013
Number of other retired or separated participants entitled to future benefits2011-09-016
Total of all active and inactive participants2011-09-01154
Total participants2011-09-01154
2010: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-01156
Total number of active participants reported on line 7a of the Form 55002010-09-01147
Number of retired or separated participants receiving benefits2010-09-012
Number of other retired or separated participants entitled to future benefits2010-09-014
Total of all active and inactive participants2010-09-01153
Total participants2010-09-01153
2009: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01132
Total number of active participants reported on line 7a of the Form 55002009-09-01151
Number of retired or separated participants receiving benefits2009-09-014
Number of other retired or separated participants entitled to future benefits2009-09-011
Total of all active and inactive participants2009-09-01156
Total participants2009-09-01156

Form 5500 Responses for MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN

2020: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Submission has been amendedYes
2020-09-01This submission is the final filingYes
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2014: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2010: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes
2009: MEDVED CHEVROLET, INC. EMPLOYEE HEALTH CARE PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AXKX
Policy instance 4
Insurance contract or identification numberGLUG0AXKX
Number of Individuals Covered216
Insurance policy start date2020-09-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,034
Total amount of fees paid to insurance companyUSD $3,276
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $30,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,393
Amount paid for insurance broker fees2977
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number915703
Policy instance 3
Insurance contract or identification number915703
Number of Individuals Covered63
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $4,378
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,800
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10021311001
Policy instance 2
Insurance contract or identification number10021311001
Number of Individuals Covered149
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $931
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $809
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number28821
Policy instance 1
Insurance contract or identification number28821
Number of Individuals Covered252
Insurance policy start date2020-09-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $48,106
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,203,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,763
Amount paid for insurance broker fees0
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number28821
Policy instance 1
Insurance contract or identification number28821
Number of Individuals Covered218
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $55,045
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,360,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,045
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10021311001
Policy instance 2
Insurance contract or identification number10021311001
Number of Individuals Covered121
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $986
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $986
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number915703
Policy instance 3
Insurance contract or identification number915703
Number of Individuals Covered59
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $4,296
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,296
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AXKX
Policy instance 4
Insurance contract or identification numberGLUG0AXKX
Number of Individuals Covered225
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $4,057
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,057
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number915703
Policy instance 6
Insurance contract or identification number915703
Number of Individuals Covered72
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $5,042
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,042
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AXKX
Policy instance 5
Insurance contract or identification numberGVTL0AXKX
Number of Individuals Covered75
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $3,363
Total amount of fees paid to insurance companyUSD $695
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,363
Amount paid for insurance broker fees695
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0AXKX
Policy instance 4
Insurance contract or identification numberGUDH0AXKX
Number of Individuals Covered51
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $977
Total amount of fees paid to insurance companyUSD $171
Other welfare benefits providedACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $9,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $977
Amount paid for insurance broker fees171
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AXKX
Policy instance 3
Insurance contract or identification numberGLUG0AXKX
Number of Individuals Covered258
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $434
Total amount of fees paid to insurance companyUSD $92
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $434
Amount paid for insurance broker fees92
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10021311001
Policy instance 2
Insurance contract or identification number10021311001
Number of Individuals Covered152
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,095
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,095
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number28821
Policy instance 1
Insurance contract or identification number28821
Number of Individuals Covered265
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $55,700
Total amount of fees paid to insurance companyUSD $341
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,396,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,700
Amount paid for insurance broker fees341
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5454228
Policy instance 2
Insurance contract or identification number5454228
Number of Individuals Covered62
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $4,295
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10021311001
Policy instance 3
Insurance contract or identification number10021311001
Number of Individuals Covered154
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,317
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AXKX
Policy instance 4
Insurance contract or identification numberGLUG0AXKX
Number of Individuals Covered249
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $412
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0AXKX
Policy instance 5
Insurance contract or identification numberGUDH0AXKX
Number of Individuals Covered52
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,060
Other welfare benefits providedACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $10,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AXKX
Policy instance 6
Insurance contract or identification numberGVTL0AXKX
Number of Individuals Covered69
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,389
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED DENTAL CARE OF COLORADO, INC (National Association of Insurance Commissioners NAIC id number: 52032 )
Policy contract number5454228
Policy instance 7
Insurance contract or identification number5454228
Number of Individuals Covered68
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of fees paid to insurance companyUSD $1,481
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,810
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 number28821
Policy instance 1
Insurance contract or identification number28821
Number of Individuals Covered291
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $59,134
Total amount of fees paid to insurance companyUSD $1,342
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,463,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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