PLAN DE SALUD DEL VALLE, INC. has sponsored the creation of one or more 401k plans.
Additional information about PLAN DE SALUD DEL VALLE, INC.
Submission information for form 5500 for 401k plan SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN
| 2023: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | No |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Submission has been amended | No |
| 2010-09-01 | This submission is the final filing | No |
| 2010-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-09-01 | Plan is a collectively bargained plan | No |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | No |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-09-01 | Type of plan entity | Single employer plan |
| 2008-09-01 | Submission has been amended | No |
| 2008-09-01 | This submission is the final filing | No |
| 2008-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-09-01 | Plan is a collectively bargained plan | No |
| 2008-09-01 | Plan funding arrangement – Insurance | Yes |
| 2008-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-09-01 | Type of plan entity | Single employer plan |
| 2007-09-01 | Submission has been amended | No |
| 2007-09-01 | This submission is the final filing | No |
| 2007-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-09-01 | Plan is a collectively bargained plan | No |
| 2007-09-01 | Plan funding arrangement – Insurance | Yes |
| 2007-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2007-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2006 form 5500 responses |
|---|
| 2006-09-01 | Type of plan entity | Single employer plan |
| 2006-09-01 | Submission has been amended | No |
| 2006-09-01 | This submission is the final filing | No |
| 2006-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-09-01 | Plan is a collectively bargained plan | No |
| 2006-09-01 | Plan funding arrangement – Insurance | Yes |
| 2006-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2006-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2005 form 5500 responses |
|---|
| 2005-09-01 | Type of plan entity | Single employer plan |
| 2005-09-01 | Submission has been amended | No |
| 2005-09-01 | This submission is the final filing | No |
| 2005-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-09-01 | Plan is a collectively bargained plan | No |
| 2005-09-01 | Plan funding arrangement – Insurance | Yes |
| 2005-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2005-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2004 form 5500 responses |
|---|
| 2004-09-01 | Type of plan entity | Single employer plan |
| 2004-09-01 | Submission has been amended | No |
| 2004-09-01 | This submission is the final filing | No |
| 2004-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-09-01 | Plan is a collectively bargained plan | No |
| 2004-09-01 | Plan funding arrangement – Insurance | Yes |
| 2004-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2004-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2003 form 5500 responses |
|---|
| 2003-09-01 | Type of plan entity | Single employer plan |
| 2003-09-01 | Submission has been amended | No |
| 2003-09-01 | This submission is the final filing | No |
| 2003-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-09-01 | Plan is a collectively bargained plan | No |
| 2003-09-01 | Plan funding arrangement – Insurance | Yes |
| 2003-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2003-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2002 form 5500 responses |
|---|
| 2002-09-01 | Type of plan entity | Single employer plan |
| 2002-09-01 | Submission has been amended | No |
| 2002-09-01 | This submission is the final filing | No |
| 2002-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-09-01 | Plan is a collectively bargained plan | No |
| 2002-09-01 | Plan funding arrangement – Insurance | Yes |
| 2002-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2002-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2001: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2001 form 5500 responses |
|---|
| 2001-09-01 | Type of plan entity | Single employer plan |
| 2001-09-01 | Submission has been amended | No |
| 2001-09-01 | This submission is the final filing | No |
| 2001-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-09-01 | Plan is a collectively bargained plan | No |
| 2001-09-01 | Plan funding arrangement – Insurance | Yes |
| 2001-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2001-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2001-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2000: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 2000 form 5500 responses |
|---|
| 2000-09-01 | Type of plan entity | Single employer plan |
| 2000-09-01 | Submission has been amended | No |
| 2000-09-01 | This submission is the final filing | No |
| 2000-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2000-09-01 | Plan is a collectively bargained plan | No |
| 2000-09-01 | Plan funding arrangement – Insurance | Yes |
| 2000-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2000-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2000-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1999: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 1999 form 5500 responses |
|---|
| 1999-09-01 | Type of plan entity | Single employer plan |
| 1999-09-01 | Submission has been amended | No |
| 1999-09-01 | This submission is the final filing | No |
| 1999-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1999-09-01 | Plan is a collectively bargained plan | No |
| 1999-09-01 | Plan funding arrangement – Insurance | Yes |
| 1999-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1999-09-01 | Plan benefit arrangement – Insurance | Yes |
| 1999-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1998: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 1998 form 5500 responses |
|---|
| 1998-09-01 | Type of plan entity | Single employer plan |
| 1998-09-01 | Submission has been amended | No |
| 1998-09-01 | This submission is the final filing | No |
| 1998-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1998-09-01 | Plan is a collectively bargained plan | No |
| 1998-09-01 | Plan funding arrangement – Insurance | Yes |
| 1998-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1998-09-01 | Plan benefit arrangement – Insurance | Yes |
| 1998-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1997: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 1997 form 5500 responses |
|---|
| 1997-09-01 | Type of plan entity | Single employer plan |
| 1997-09-01 | Submission has been amended | No |
| 1997-09-01 | This submission is the final filing | Yes |
| 1997-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1997-09-01 | Plan is a collectively bargained plan | No |
| 1997-09-01 | Plan funding arrangement – Insurance | Yes |
| 1997-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1997-09-01 | Plan benefit arrangement – Insurance | Yes |
| 1997-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1996: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 1996 form 5500 responses |
|---|
| 1996-09-01 | Type of plan entity | Single employer plan |
| 1996-09-01 | Submission has been amended | No |
| 1996-09-01 | This submission is the final filing | No |
| 1996-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1996-09-01 | Plan is a collectively bargained plan | No |
| 1996-09-01 | Plan funding arrangement – Insurance | Yes |
| 1996-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1996-09-01 | Plan benefit arrangement – Insurance | Yes |
| 1996-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1995: SALUD FAMILY HEALTH, INC. EMPLOYEE BENEFIT PLAN 1995 form 5500 responses |
|---|
| 1995-09-01 | Type of plan entity | Single employer plan |
| 1995-09-01 | Submission has been amended | No |
| 1995-09-01 | This submission is the final filing | No |
| 1995-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1995-09-01 | Plan is a collectively bargained plan | No |
| 1995-09-01 | Plan funding arrangement – Insurance | Yes |
| 1995-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1995-09-01 | Plan benefit arrangement – Insurance | Yes |
| 1995-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 1 |
| Insurance contract or identification number | 12400 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $5,124 | | 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? | No |
|
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 2 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $38,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 935413 |
| Policy instance | 3 |
| Insurance contract or identification number | 935413 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $3,830 | | Total amount of fees paid to insurance company | USD $638 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $31,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 59669 |
| Policy instance | 4 |
| Insurance contract or identification number | 59669 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $65,348 | | Total amount of fees paid to insurance company | USD $10,201 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $525,589 | | 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 number | 98082541001 |
| Policy instance | 5 |
| Insurance contract or identification number | 98082541001 | | Number of Individuals Covered | 824 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $4,056 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $49,431 | | 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 number | 98082541001 |
| Policy instance | 5 |
| Insurance contract or identification number | 98082541001 | | Number of Individuals Covered | 837 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,242 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $40,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 59669 |
| Policy instance | 4 |
| Insurance contract or identification number | 59669 | | Number of Individuals Covered | 610 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $62,632 | | Total amount of fees paid to insurance company | USD $10,138 | | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $522,211 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 935413 |
| Policy instance | 3 |
| Insurance contract or identification number | 935413 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,665 | | Total amount of fees paid to insurance company | USD $611 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $30,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 2 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $37,768 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 1 |
| Insurance contract or identification number | 12400 | | Number of Individuals Covered | 471 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,393 | | 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? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98082541001 |
| Policy instance | 2 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 1 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 935413 |
| Policy instance | 4 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 59669 |
| Policy instance | 5 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98082541001 |
| Policy instance | 2 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 3 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 935413 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 59669 |
| Policy instance | 5 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98082541001 |
| Policy instance | 2 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 3 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
| Policy contract number | 935413 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 59669 |
| Policy instance | 5 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98082541001 |
| Policy instance | 3 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 596690001 |
| Policy instance | 1 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0663013 |
| Policy instance | 5 |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) |
| Policy contract number | 12400 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 596690001 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 98082541001 |
| Policy instance | 3 |
| MINES AND ASSOCIATES, P.C. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 00 |
| Policy instance | 4 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30719 |
| Policy instance | 4 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0478151 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 1 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 9752572406 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 9752572406 |
| Policy instance | 1 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30719 |
| Policy instance | 2 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL30719 |
| Policy instance | 3 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 9752572406 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 2 |
| ROCKY MOUNTAIN HEALTH CARE OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47004 ) |
| Policy contract number | RMH20015 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 9752572406 |
| Policy instance | 1 |
| ROCKY MOUNTAIN HEALTH CARE OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47004 ) |
| Policy contract number | RMH20015 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| ROCKY MOUNTAIN HEALTH CARE OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47004 ) |
| Policy contract number | RMH20015 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 1 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 32052 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 2 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL25958 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 00032052 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 2 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL25958 |
| Policy instance | 3 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL25958 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 2 |
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL25958 |
| Policy instance | 3 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 1 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 1601009700 |
| Policy instance | 2 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 1601009700 |
| Policy instance | 1 |
| UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 ) |
| Policy contract number | 23327 |
| Policy instance | 4 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 3 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 2 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 2 |
| UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 ) |
| Policy contract number | 23327 |
| Policy instance | 4 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 1601009700 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 1 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 1 |
| UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 ) |
| Policy contract number | 23327 |
| Policy instance | 2 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | EL006134 |
| Policy instance | 3 |
| LINCOLN NATIONAL LIFE (National Association of Insurance Commissioners NAIC id number: 38830 ) |
| Policy contract number | AIC5050000627 |
| Policy instance | 2 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 3 |
| UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 ) |
| Policy contract number | 23327 |
| Policy instance | 1 |
| AVEMCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | AIC5000000676 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 1 |
| UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 ) |
| Policy contract number | 23327 |
| Policy instance | 2 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G214425 |
| Policy instance | 3 |
| AVEMCO INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | AIC5000000676 |
| Policy instance | 4 |
| SECURITY LIFE OF DENVER INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68713 ) |
| Policy contract number | G45621 |
| Policy instance | 2 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 23327001 |
| Policy instance | 1 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 23327001 |
| Policy instance | 1 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 5621 |
| Policy instance | 2 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 23327001 |
| Policy instance | 3 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 5621 |
| Policy instance | 2 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 5621 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 059669 |
| Policy instance | 1 |
| ROYAL MACCABEES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 23327001 |
| Policy instance | 2 |
