ARC THRIFT STORES INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN
401k plan membership statisitcs for METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN
| Measure | Date | Value |
|---|
| 2021: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 579 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 563 |
| Total of all active and inactive participants | 2021-10-01 | 563 |
| Total participants | 2021-10-01 | 563 |
| 2020: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 502 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 579 |
| Total of all active and inactive participants | 2020-10-01 | 579 |
| Total participants | 2020-10-01 | 579 |
| 2019: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 656 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 502 |
| Total of all active and inactive participants | 2019-10-01 | 502 |
| Total participants | 2019-10-01 | 502 |
| 2018: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 785 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 656 |
| Total of all active and inactive participants | 2018-10-01 | 656 |
| Total participants | 2018-10-01 | 656 |
| 2017: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 750 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 785 |
| Total of all active and inactive participants | 2017-10-01 | 785 |
| Total participants | 2017-10-01 | 785 |
| 2016: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 751 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 750 |
| Total of all active and inactive participants | 2016-10-01 | 750 |
| Total participants | 2016-10-01 | 750 |
| 2015: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 738 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 751 |
| Total of all active and inactive participants | 2015-10-01 | 751 |
| Total participants | 2015-10-01 | 0 |
| 2014: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 671 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 738 |
| Total of all active and inactive participants | 2014-10-01 | 738 |
| Total participants | 2014-10-01 | 0 |
| 2013: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 617 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 671 |
| Total of all active and inactive participants | 2013-10-01 | 671 |
| Total participants | 2013-10-01 | 0 |
| 2012: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 465 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 617 |
| Total of all active and inactive participants | 2012-10-01 | 617 |
| Total participants | 2012-10-01 | 0 |
| 2011: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 404 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 465 |
| Total of all active and inactive participants | 2011-10-01 | 465 |
| Total participants | 2011-10-01 | 465 |
| 2009: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 399 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 390 |
| Total of all active and inactive participants | 2009-10-01 | 390 |
| Total participants | 2009-10-01 | 390 |
| 2021: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: METROPOLITAN ASSN FOR RETARDED CITIZENS INC MEDICAL PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962890 |
| Policy instance | 10 |
| Insurance contract or identification number | VDT962890 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $5,996 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,996 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | L00825 |
| Policy instance | 1 |
| Insurance contract or identification number | L00825 | | Number of Individuals Covered | 563 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $40,472 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,717,549 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,472 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 1395 |
| Policy instance | 2 |
| Insurance contract or identification number | 1395 | | Number of Individuals Covered | 756 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $8,933 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,933 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10183951001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10183951001 | | Number of Individuals Covered | 672 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969086 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX969086 | | Number of Individuals Covered | 944 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $29,801 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,762 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,801 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970545 |
| Policy instance | 5 |
| Insurance contract or identification number | OK970545 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,792 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,792 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962889 |
| Policy instance | 6 |
| Insurance contract or identification number | VDT962889 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $23,094 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,094 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961146 |
| Policy instance | 7 |
| Insurance contract or identification number | AI961146 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,222 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $43,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,222 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961102 |
| Policy instance | 8 |
| Insurance contract or identification number | CI961102 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,333 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $65,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,333 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960499 |
| Policy instance | 9 |
| Insurance contract or identification number | HC960499 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,333 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HOSPITAL CARE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,333 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | HC960499 |
| Policy instance | 9 |
| Insurance contract or identification number | HC960499 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $33,874 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HOSPITAL CARE | | Welfare Benefit Premiums Paid to Carrier | USD $70,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,874 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | CI961102 |
| Policy instance | 8 |
| Insurance contract or identification number | CI961102 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $41,546 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $83,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,546 | | Insurance broker organization code? | 3 |
|
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | L00825 |
| Policy instance | 1 |
| Insurance contract or identification number | L00825 | | Number of Individuals Covered | 579 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of fees paid to insurance company | USD $25,965 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,748,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 25965 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 1395 |
| Policy instance | 2 |
| Insurance contract or identification number | 1395 | | Number of Individuals Covered | 746 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $9,518 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,518 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10183951001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10183951001 | | Number of Individuals Covered | 647 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,545 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX969086 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX969086 | | Number of Individuals Covered | 960 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of fees paid to insurance company | USD $2,146 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2146 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK970545 |
| Policy instance | 5 |
| Insurance contract or identification number | OK970545 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of fees paid to insurance company | USD $225 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL LIFE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 225 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT962889 |
| Policy instance | 6 |
| Insurance contract or identification number | VDT962889 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of fees paid to insurance company | USD $1,992 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1992 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | AI961146 |
| Policy instance | 7 |
| Insurance contract or identification number | AI961146 | | Number of Individuals Covered | 316 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $27,921 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL INJURY | | Welfare Benefit Premiums Paid to Carrier | USD $53,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,921 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342026 |
| Policy instance | 1 |
| Insurance contract or identification number | 3342026 | | Number of Individuals Covered | 502 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of fees paid to insurance company | USD $24,580 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,138,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12580 | | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3342026 |
| Policy instance | 1 |
| Insurance contract or identification number | 3342026 | | Number of Individuals Covered | 656 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,551,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 752127 |
| Policy instance | 1 |
| Insurance contract or identification number | 752127 | | Number of Individuals Covered | 785 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,420,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
