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JEFFERSON HILLS WELFARE BENEFIT PLAN 401k Plan overview

Plan NameJEFFERSON HILLS WELFARE BENEFIT PLAN
Plan identification number 501

JEFFERSON HILLS WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

JEFFERSON HILLS CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:JEFFERSON HILLS CORPORATION
Employer identification number (EIN):841241983
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about JEFFERSON HILLS CORPORATION

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1993-09-07
Company Identification Number: 19931093247
Legal Registered Office Address: 421 ZANG ST

Lakewood
United States of America (USA)
80228

More information about JEFFERSON HILLS CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEFFERSON HILLS WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01KAREN YARBERRY
5012016-01-01KAREN YARBERRY
5012015-01-01KAREN YARBERRY KAREN YARBERRY2016-10-14
5012014-01-01KAREN YARBERRY KAREN YARBERRY2015-10-05
5012013-01-01KAREN YARBERRY
5012012-01-01KAREN YARBERRY
5012011-01-01KAREN YARBERRY
5012009-01-01KAREN YARBERRY

Plan Statistics for JEFFERSON HILLS WELFARE BENEFIT PLAN

401k plan membership statisitcs for JEFFERSON HILLS WELFARE BENEFIT PLAN

Measure Date Value
2021: JEFFERSON HILLS WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01105
Total number of active participants reported on line 7a of the Form 55002021-01-0163
Total of all active and inactive participants2021-01-0163
Total participants2021-01-0163
2020: JEFFERSON HILLS WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01145
Total number of active participants reported on line 7a of the Form 55002020-01-01105
Total of all active and inactive participants2020-01-01105
Total participants2020-01-01105
2019: JEFFERSON HILLS WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01202
Total number of active participants reported on line 7a of the Form 55002019-01-01145
Total of all active and inactive participants2019-01-01145
Total participants2019-01-01145
2018: JEFFERSON HILLS WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01209
Total number of active participants reported on line 7a of the Form 55002018-01-01202
Total of all active and inactive participants2018-01-01202
Total participants2018-01-01202
2017: JEFFERSON HILLS WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01229
Total number of active participants reported on line 7a of the Form 55002017-01-01207
Number of retired or separated participants receiving benefits2017-01-012
Total of all active and inactive participants2017-01-01209
Total participants2017-01-01209
2016: JEFFERSON HILLS WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01165
Total number of active participants reported on line 7a of the Form 55002016-01-01226
Number of retired or separated participants receiving benefits2016-01-013
Total of all active and inactive participants2016-01-01229
Total participants2016-01-01229
2015: JEFFERSON HILLS WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01154
Total number of active participants reported on line 7a of the Form 55002015-01-01165
Total of all active and inactive participants2015-01-01165
Total participants2015-01-01165
2014: JEFFERSON HILLS WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01196
Total number of active participants reported on line 7a of the Form 55002014-01-01154
Total of all active and inactive participants2014-01-01154
Total participants2014-01-01154
2013: JEFFERSON HILLS WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01157
Total number of active participants reported on line 7a of the Form 55002013-01-01194
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01196
Total participants2013-01-01196
2012: JEFFERSON HILLS WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01141
Total number of active participants reported on line 7a of the Form 55002012-01-01156
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01157
Total participants2012-01-01157
2011: JEFFERSON HILLS WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01137
Total number of active participants reported on line 7a of the Form 55002011-01-01139
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-01141
Total participants2011-01-01141
2009: JEFFERSON HILLS WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01161
Total number of active participants reported on line 7a of the Form 55002009-01-01157
Number of retired or separated participants receiving benefits2009-01-0113
Total of all active and inactive participants2009-01-01170
Total participants2009-01-01170

Form 5500 Responses for JEFFERSON HILLS WELFARE BENEFIT PLAN

2021: JEFFERSON HILLS WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: JEFFERSON HILLS WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: JEFFERSON HILLS WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: JEFFERSON HILLS WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: JEFFERSON HILLS WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: JEFFERSON HILLS WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: JEFFERSON HILLS WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: JEFFERSON HILLS WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: JEFFERSON HILLS WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: JEFFERSON HILLS WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: JEFFERSON HILLS WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: JEFFERSON HILLS WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 6
Insurance contract or identification number31517
Number of Individuals Covered63
Insurance policy start date2021-01-01
Insurance policy end date2021-12-01
Total amount of commissions paid to insurance brokerUSD $15,512
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $450,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,512
Insurance broker organization code?3
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 1
Insurance contract or identification number000008060
Number of Individuals Covered80
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,575
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,575
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberS0K603973
Policy instance 2
Insurance contract or identification numberS0K603973
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $62
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96895711001
Policy instance 3
Insurance contract or identification number96895711001
Number of Individuals Covered70
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $694
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $694
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605839
Policy instance 4
Insurance contract or identification numberSGD605839
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,852
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,852
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605731
Policy instance 5
Insurance contract or identification numberSGM605731
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $334
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $334
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberS0K603973
Policy instance 2
Insurance contract or identification numberS0K603973
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $45
Total amount of fees paid to insurance companyUSD $27
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45
Amount paid for insurance broker fees27
Insurance broker organization code?3
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 1
Insurance contract or identification number000008060
Number of Individuals Covered105
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,040
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,040
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96895711001
Policy instance 3
Insurance contract or identification number96895711001
Number of Individuals Covered94
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $980
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $980
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605731
Policy instance 4
Insurance contract or identification numberSGM605731
Number of Individuals Covered50
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $227
Total amount of fees paid to insurance companyUSD $137
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $227
Amount paid for insurance broker fees137
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 5
Insurance contract or identification number31517
Number of Individuals Covered86
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,782
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $661,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,782
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605839
Policy instance 6
Insurance contract or identification numberSGD605839
Number of Individuals Covered38
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $725
Total amount of fees paid to insurance companyUSD $416
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $725
Amount paid for insurance broker fees416
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 2
Insurance contract or identification number31517
Number of Individuals Covered121
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $32,839
Total amount of fees paid to insurance companyUSD $572
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,062,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,839
Amount paid for insurance broker fees572
Additional information about fees paid to insurance brokerLBG BOB BONUS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96895711001
Policy instance 6
Insurance contract or identification number96895711001
Number of Individuals Covered121
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,632
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,632
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605839
Policy instance 1
Insurance contract or identification numberSGD605839
Number of Individuals Covered145
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $3,126
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,126
Insurance broker organization code?3
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 3
Insurance contract or identification number000008060
Number of Individuals Covered138
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,626
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,626
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberS0K603973
Policy instance 5
Insurance contract or identification numberS0K603973
Number of Individuals Covered145
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $190
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $190
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605731
Policy instance 4
Insurance contract or identification numberSGM605731
Number of Individuals Covered145
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $958
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $958
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605731
Policy instance 1
Insurance contract or identification numberSGM605731
Number of Individuals Covered212
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,191
Total amount of fees paid to insurance companyUSD $124
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,191
Amount paid for insurance broker fees124
Insurance broker organization code?3
Insurance broker nameIMA INC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 6
Insurance contract or identification number000008060
Number of Individuals Covered174
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,265
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,265
Insurance broker organization code?3
Insurance broker nameIMA INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberS0K603973
Policy instance 2
Insurance contract or identification numberS0K603973
Number of Individuals Covered212
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $312
Total amount of fees paid to insurance companyUSD $25
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $312
Amount paid for insurance broker fees25
Insurance broker organization code?3
Insurance broker nameIMA, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605839
Policy instance 3
Insurance contract or identification numberSGD605839
Number of Individuals Covered212
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,420
Total amount of fees paid to insurance companyUSD $320
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,420
Amount paid for insurance broker fees320
Insurance broker organization code?3
Insurance broker nameIMA, INC.
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 5
Insurance contract or identification number31517
Number of Individuals Covered207
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $39,714
Total amount of fees paid to insurance companyUSD $594
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,412,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,714
Amount paid for insurance broker fees594
Additional information about fees paid to insurance brokerLBG BOB BONUS
Insurance broker organization code?3
Insurance broker nameIMA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96895711001
Policy instance 4
Insurance contract or identification number96895711001
Number of Individuals Covered154
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,522
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,522
Insurance broker organization code?3
Insurance broker nameIMA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 6
Insurance contract or identification number9689571
Number of Individuals Covered180
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,470
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,470
Insurance broker organization code?3
Insurance broker nameIMA INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM605731
Policy instance 1
Insurance contract or identification numberSGM605731
Number of Individuals Covered127
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $943
Total amount of fees paid to insurance companyUSD $346
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $943
Amount paid for insurance broker fees346
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameIMA INC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 2
Insurance contract or identification number000008060
Number of Individuals Covered197
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,756
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,756
Insurance broker organization code?3
Insurance broker nameIMA INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberS0K603973
Policy instance 3
Insurance contract or identification numberS0K603973
Number of Individuals Covered127
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $69
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees69
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameIMA, INC.
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 4
Insurance contract or identification number31517
Number of Individuals Covered223
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $33,284
Total amount of fees paid to insurance companyUSD $2,387
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,129,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,284
Amount paid for insurance broker fees2387
Additional information about fees paid to insurance brokerLBG RETENTION BONUS
Insurance broker organization code?3
Insurance broker nameIMA INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD605839
Policy instance 5
Insurance contract or identification numberSGD605839
Number of Individuals Covered127
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,729
Total amount of fees paid to insurance companyUSD $835
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,729
Amount paid for insurance broker fees835
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameIMA, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 3
Insurance contract or identification number9689571
Number of Individuals Covered158
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,338
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,338
Insurance broker organization code?3
Insurance broker nameIMA INC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000008060
Policy instance 2
Insurance contract or identification number000008060
Number of Individuals Covered157
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,575
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,575
Insurance broker organization code?3
Insurance broker nameIMA INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number300661
Policy instance 1
Insurance contract or identification number300661
Number of Individuals Covered127
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,160
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $78,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,160
Insurance broker organization code?3
Insurance broker nameIMA INC
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 4
Insurance contract or identification number31517
Number of Individuals Covered179
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $32,483
Total amount of fees paid to insurance companyUSD $2,156
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,063,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,483
Amount paid for insurance broker fees2156
Additional information about fees paid to insurance brokerLBG RETENTION BONUS
Insurance broker organization code?3
Insurance broker nameIMA INC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number8060
Policy instance 3
Insurance contract or identification number8060
Number of Individuals Covered159
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,526
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,526
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number300661
Policy instance 1
Insurance contract or identification number300661
Number of Individuals Covered130
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,379
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,379
Insurance broker organization code?3
Insurance broker nameIMA INC
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 2
Insurance contract or identification number31517
Number of Individuals Covered194
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $34,647
Total amount of fees paid to insurance companyUSD $1,881
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,064,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,647
Amount paid for insurance broker fees1881
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 4
Insurance contract or identification number9689571
Number of Individuals Covered157
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,594
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,594
Insurance broker organization code?3
Insurance broker nameIMA INC
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 2
Insurance contract or identification number31517
Number of Individuals Covered156
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $47,654
Total amount of fees paid to insurance companyUSD $1,496
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $844,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,654
Amount paid for insurance broker fees1496
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 3
Insurance contract or identification number9689571
Number of Individuals Covered152
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,304
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Insurance broker organization code?3
Insurance broker nameIMA INC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number8060
Policy instance 4
Insurance contract or identification number8060
Number of Individuals Covered151
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,229
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,229
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number300661
Policy instance 1
Insurance contract or identification number300661
Number of Individuals Covered119
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,963
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,963
Insurance broker organization code?3
Insurance broker nameIMA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 4
Insurance contract or identification number9689571
Number of Individuals Covered129
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,093
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,078
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 number8060
Policy instance 1
Insurance contract or identification number8060
Number of Individuals Covered139
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,969
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
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 number31517
Policy instance 2
Insurance contract or identification number31517
Number of Individuals Covered127
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $29,756
Total amount of fees paid to insurance companyUSD $1,188
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $729,925
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 number300661
Policy instance 3
Insurance contract or identification number300661
Number of Individuals Covered115
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,399
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,021
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 number300661
Policy instance 1
Insurance contract or identification number300661
Number of Individuals Covered82
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $445
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $32,485
Commission paid to Insurance BrokerUSD $445
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number31517
Policy instance 3
Insurance contract or identification number31517
Number of Individuals Covered111
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $30,224
Total amount of fees paid to insurance companyUSD $13,300
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $651,806
Commission paid to Insurance BrokerUSD $30,224
Amount paid for insurance broker fees13300
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9689571
Policy instance 4
Insurance contract or identification number9689571
Number of Individuals Covered111
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,276
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,467
Commission paid to Insurance BrokerUSD $1,276
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number8060
Policy instance 2
Insurance contract or identification number8060
Number of Individuals Covered124
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,146
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $2,146
Insurance broker organization code?3
Insurance broker nameIMA OF COLORADO

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