SUMMITSTONE HEALTH PARTNERS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN)
401k plan membership statisitcs for SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN)
| Measure | Date | Value |
|---|
| 2022: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 371 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 471 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 2 |
| Total of all active and inactive participants | 2022-01-01 | 473 |
| 2021: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 345 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 371 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
| Total of all active and inactive participants | 2021-01-01 | 373 |
| 2020: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 328 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 333 |
| Total of all active and inactive participants | 2020-01-01 | 333 |
| 2019: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 383 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 328 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 41 |
| Total of all active and inactive participants | 2019-01-01 | 370 |
| 2018: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 334 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 48 |
| Total of all active and inactive participants | 2018-01-01 | 383 |
| 2017: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 251 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 252 |
| 2016: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 211 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1 |
| Total of all active and inactive participants | 2016-01-01 | 212 |
| 2015: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 255 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 216 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 1 |
| Total of all active and inactive participants | 2015-01-01 | 217 |
| 2014: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 255 |
| Total of all active and inactive participants | 2014-01-01 | 255 |
| 2013: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 151 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 1 |
| Total of all active and inactive participants | 2013-01-01 | 152 |
| 2012: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 151 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 151 |
| 2011: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 161 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 1 |
| Total of all active and inactive participants | 2011-01-01 | 162 |
| 2010: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 127 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 2 |
| Total of all active and inactive participants | 2010-01-01 | 129 |
| 2009: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 153 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 153 |
| 2022: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: SUMMITSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN (FORMERLY TOUCHSTONE HEALTH PARTNERS WELFARE BENEFIT PLAN) 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 3 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $9,625 | | Total amount of fees paid to insurance company | USD $6,653 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,248 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,625 | | Amount paid for insurance broker fees | 4435 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | 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 | 0613558 |
| Policy instance | 2 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 418 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $117,931 | | Total amount of fees paid to insurance company | USD $5,321 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,469,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $117,931 | | Amount paid for insurance broker fees | 5321 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | 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 | 0613558 |
| Policy instance | 1 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $18,603 | | Total amount of fees paid to insurance company | USD $1,024 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $289,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,603 | | Amount paid for insurance broker fees | 1024 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $4,004 | | Total amount of fees paid to insurance company | USD $3,300 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $40,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,004 | | Amount paid for insurance broker fees | 2200 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | 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 | 0613558 |
| Policy instance | 1 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $22,431 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $226,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,431 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 2 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,466 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,466 | | 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 | 0613558 |
| Policy instance | 3 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 327 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $89,481 | | Total amount of fees paid to insurance company | USD $6,151 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,075,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $89,481 | | Amount paid for insurance broker fees | 6151 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $5,455 | | Total amount of fees paid to insurance company | USD $3,191 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,547 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,455 | | Amount paid for insurance broker fees | 1718 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BCT8 |
| Policy instance | 5 |
| Insurance contract or identification number | GLUG0BCT8 | | Number of Individuals Covered | 348 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $3,321 | | Total amount of fees paid to insurance company | USD $2,030 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE & AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $33,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,321 | | Amount paid for insurance broker fees | 1093 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | 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 | 0613558 |
| Policy instance | 1 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $18,072 | | Total amount of fees paid to insurance company | USD $984 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $182,824 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,072 | | Amount paid for insurance broker fees | 984 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 2 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,479 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,479 | | 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 | 0613558 |
| Policy instance | 3 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $99,168 | | Total amount of fees paid to insurance company | USD $4,246 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,091,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $99,168 | | Amount paid for insurance broker fees | 4246 | | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $2,995 | | Total amount of fees paid to insurance company | USD $601 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $29,947 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,995 | | Amount paid for insurance broker fees | 601 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $4,337 | | Total amount of fees paid to insurance company | USD $871 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,368 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,337 | | Amount paid for insurance broker fees | 871 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $3,710 | | Total amount of fees paid to insurance company | USD $1,054 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,710 | | Amount paid for insurance broker fees | 1054 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | 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 | 0613558 |
| Policy instance | 3 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $82,121 | | Total amount of fees paid to insurance company | USD $2,819 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $873,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $82,121 | | Amount paid for insurance broker fees | 2819 | | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION 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 | 0613558 |
| Policy instance | 1 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $18,167 | | Total amount of fees paid to insurance company | USD $339 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $183,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,167 | | Amount paid for insurance broker fees | 339 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 2 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,418 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,418 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000BCT8 |
| Policy instance | 5 |
| Insurance contract or identification number | G000BCT8 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $2,553 | | Total amount of fees paid to insurance company | USD $416 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $25,527 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,553 | | Amount paid for insurance broker fees | 416 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 6 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $302 | | Total amount of fees paid to insurance company | USD $122 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,023 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $302 | | Amount paid for insurance broker fees | 122 | | 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 | 0613558 |
| Policy instance | 1 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 245 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $14,199 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,945 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,199 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 2 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,353 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,353 | | 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 | 0613558 |
| Policy instance | 3 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $77,321 | | Total amount of fees paid to insurance company | USD $0 | | Health 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 $77,321 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 4 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,995 | | Total amount of fees paid to insurance company | USD $2,389 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,995 | | Amount paid for insurance broker fees | 803 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 5 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 383 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $6,115 | | Total amount of fees paid to insurance company | USD $7,481 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,115 | | Amount paid for insurance broker fees | 2506 | | Insurance broker organization code? | 3 |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $6,244 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,244 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $301 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $301 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 0613558 |
| Policy instance | 4 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $12,446 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,446 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $1,305 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,305 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 0613558 |
| Policy instance | 6 |
| Insurance contract or identification number | 0613558 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $73,190 | | Total amount of fees paid to insurance company | USD $0 | | Health 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 $73,190 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $1,988 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,988 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $1,942 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,942 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 1191432885 |
| Policy instance | 4 |
| Insurance contract or identification number | 1191432885 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $14,088 | | Total amount of fees paid to insurance company | USD $10 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,392 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 10 | | Additional information about fees paid to insurance broker | OTHER NON-MONETARY COMPENSATION | | Insurance broker name | BETA HEALTH ASSOCIATION INC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $294 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,942 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $294 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $6,133 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,328 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,133 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30049684 |
| Policy instance | 5 |
| Insurance contract or identification number | 30049684 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $1,244 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,244 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331835 |
| Policy instance | 4 |
| Insurance contract or identification number | 3331835 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $8,291 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,291 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $206 | | Total amount of fees paid to insurance company | USD $42 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $206 | | Amount paid for insurance broker fees | 42 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-07-01 | | Total amount of commissions paid to insurance broker | USD $4,322 | | Total amount of fees paid to insurance company | USD $833 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,322 | | Amount paid for insurance broker fees | 833 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,331 | | Total amount of fees paid to insurance company | USD $261 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,307 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,331 | | Amount paid for insurance broker fees | 261 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00359052 |
| Policy instance | 5 |
| Insurance contract or identification number | 00359052 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 00359052 |
| Policy instance | 5 |
| Insurance contract or identification number | 00359052 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3331835 |
| Policy instance | 4 |
| Insurance contract or identification number | 3331835 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $7,679 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,679 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $209 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $209 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-07-01 | | Total amount of commissions paid to insurance broker | USD $3,900 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,900 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $1,256 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,256 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 359052 |
| Policy instance | 5 |
| Insurance contract or identification number | 359052 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $1,077 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,077 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3331838 |
| Policy instance | 4 |
| Insurance contract or identification number | 3331838 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $6,670 | | Total amount of fees paid to insurance company | USD $188 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,670 | | Amount paid for insurance broker fees | 188 | | Additional information about fees paid to insurance broker | INCENTIVE COMPENSATION PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-07-01 | | Total amount of commissions paid to insurance broker | USD $172 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $172 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-07-01 | | Total amount of commissions paid to insurance broker | USD $3,412 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,412 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 359052 |
| Policy instance | 5 |
| Insurance contract or identification number | 359052 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3331838 |
| Policy instance | 4 |
| Insurance contract or identification number | 3331838 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $6,615 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,422 | | 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 | OK 964582 |
| Policy instance | 3 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-07-01 | | Total amount of commissions paid to insurance broker | USD $156 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,700 | | 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 | LK 962130 |
| Policy instance | 2 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-07-01 | | Total amount of commissions paid to insurance broker | USD $3,109 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,086 | | 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 | FLX962919 |
| Policy instance | 1 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $977 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,198 | | 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 | FLX962919 |
| Policy instance | 2 |
| Insurance contract or identification number | FLX962919 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $1,024 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,240 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,024 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 962130 |
| Policy instance | 3 |
| Insurance contract or identification number | LK 962130 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-07-01 | | Total amount of commissions paid to insurance broker | USD $3,313 | | Total amount of fees paid to insurance company | USD $767 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,313 | | Amount paid for insurance broker fees | 767 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3331838 |
| Policy instance | 5 |
| Insurance contract or identification number | 3331838 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $103,943 | | 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 | OK 964582 |
| Policy instance | 4 |
| Insurance contract or identification number | OK 964582 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-07-01 | | Total amount of commissions paid to insurance broker | USD $171 | | Total amount of fees paid to insurance company | USD $37 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $171 | | Amount paid for insurance broker fees | 37 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 359052 |
| Policy instance | 6 |
| Insurance contract or identification number | 359052 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | KM05727531 |
| Policy instance | 1 |
| Insurance contract or identification number | KM05727531 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $345 | | Total amount of fees paid to insurance company | USD $219 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $-66 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $345 | | Amount paid for insurance broker fees | 219 | | Insurance broker organization code? | 3 | | Insurance broker name | SHIRAZI BENEFITS LLC |
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