MERIT MEDICAL SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Additional information about MERIT MEDICAL SYSTEMS, INC.
Submission information for form 5500 for 401k plan MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN
401k plan membership statisitcs for MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2022: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,977 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,849 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 22 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 1,871 |
| Total participants | 2022-01-01 | 1,871 |
| 2021: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,966 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,926 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 14 |
| Total of all active and inactive participants | 2021-01-01 | 1,940 |
| Total participants | 2021-01-01 | 1,940 |
| 2020: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 2,221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,903 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 25 |
| Total of all active and inactive participants | 2020-01-01 | 1,928 |
| Total participants | 2020-01-01 | 1,928 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Number of participants with account balances | 2020-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 0 |
| 2019: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,977 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 2,127 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 17 |
| Total of all active and inactive participants | 2019-01-01 | 2,144 |
| Total participants | 2019-01-01 | 2,144 |
| 2018: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,835 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,902 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 17 |
| Total of all active and inactive participants | 2018-01-01 | 1,919 |
| Total participants | 2018-01-01 | 1,919 |
| 2017: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 2,781 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 2,479 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 433 |
| Total of all active and inactive participants | 2017-01-01 | 2,912 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 2,912 |
| Number of participants with account balances | 2017-01-01 | 2,174 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 237 |
| 2016: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,975 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 2,058 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 26 |
| Total of all active and inactive participants | 2016-01-01 | 2,084 |
| Total participants | 2016-01-01 | 2,084 |
| 2015: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,811 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,949 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 26 |
| Total of all active and inactive participants | 2015-01-01 | 1,975 |
| Total participants | 2015-01-01 | 1,975 |
| 2014: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,745 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 2,139 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 16 |
| Total of all active and inactive participants | 2014-01-01 | 2,155 |
| Total participants | 2014-01-01 | 2,155 |
| 2013: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 1,602 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,723 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 22 |
| Total of all active and inactive participants | 2013-01-01 | 1,745 |
| Total participants | 2013-01-01 | 1,745 |
| 2012: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 1,521 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,601 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Total of all active and inactive participants | 2012-01-01 | 1,602 |
| Total participants | 2012-01-01 | 1,602 |
| 2011: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 1,536 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,520 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 1 |
| Total of all active and inactive participants | 2011-01-01 | 1,521 |
| Total participants | 2011-01-01 | 1,521 |
| 2010: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 1,453 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,535 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 1 |
| Total of all active and inactive participants | 2010-01-01 | 1,536 |
| Total participants | 2010-01-01 | 1,536 |
| 2009: MERIT MEDICAL SYSTEMS, INC. CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 1,096 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,452 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 1 |
| Total of all active and inactive participants | 2009-01-01 | 1,453 |
| Total participants | 2009-01-01 | 1,453 |
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 2760 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-018099-00 |
| Policy instance | 5 |
| Insurance contract or identification number | 01-018099-00 | | Number of Individuals Covered | 2628 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $30,736 | | Total amount of fees paid to insurance company | USD $48,245 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,488,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,901 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 48245 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 10671-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 10671-00 | | Number of Individuals Covered | 1887 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of fees paid to insurance company | USD $82,084 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,172,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 82084 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2849 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $414 | | Total amount of fees paid to insurance company | USD $2,973 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $294,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $414 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2973 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 531 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $74,681 | | 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 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2868 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,244 | | Total amount of fees paid to insurance company | USD $3,551 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $349,574 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,244 | | Amount paid for insurance broker fees | 3551 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202639 |
| Policy instance | 4 |
| Insurance contract or identification number | UNI-202639 | | Number of Individuals Covered | 1938 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $81,310 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,161,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,310 | | Insurance broker organization code? | 3 |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 2849 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-01-01 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-018099-00 |
| Policy instance | 5 |
| Insurance contract or identification number | 01-018099-00 | | Number of Individuals Covered | 2792 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $29,083 | | Total amount of fees paid to insurance company | USD $40,180 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,424,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,083 | | Amount paid for insurance broker fees | 40180 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | 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 | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 599 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $283 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $92,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $283 | | 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 | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 774 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,229 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $106,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,229 | | Insurance broker organization code? | 3 |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 2945 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 1260 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,049 | | Total amount of fees paid to insurance company | USD $5,080 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $336,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,049 | | Amount paid for insurance broker fees | 5080 | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-018099-00 |
| Policy instance | 5 |
| Insurance contract or identification number | 01-018099-00 | | Number of Individuals Covered | 2775 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $25,135 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,227,021 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,135 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202639 |
| Policy instance | 4 |
| Insurance contract or identification number | UNI-202639 | | Number of Individuals Covered | 1953 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $79,568 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,136,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79,568 | | Insurance broker organization code? | 3 |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 3101 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $100,527 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $100,527 | | 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 | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 889 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,715 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $125,351 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,715 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2622 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,551 | | Total amount of fees paid to insurance company | USD $1,932 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $303,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,551 | | Amount paid for insurance broker fees | 1932 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202639 |
| Policy instance | 4 |
| Insurance contract or identification number | UNI-202639 | | Number of Individuals Covered | 2134 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $23,434 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $985,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,434 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53038 |
| Policy instance | 5 |
| Insurance contract or identification number | 53038 | | Number of Individuals Covered | 4077 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $83,110 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DBL, TDB, PAID FAMILY LEAVE | | Welfare Benefit Premiums Paid to Carrier | USD $1,558,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $83,110 | | Insurance broker organization code? | 3 |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 6928 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $96,768 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $96,768 | | 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 | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 849 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,953 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $107,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,953 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2622 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,551 | | Total amount of fees paid to insurance company | USD $1,932 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $303,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,551 | | Amount paid for insurance broker fees | 1932 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202639 |
| Policy instance | 4 |
| Insurance contract or identification number | UNI-202639 | | Number of Individuals Covered | 2035 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $61,799 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $882,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,799 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 53038 |
| Policy instance | 5 |
| Insurance contract or identification number | 53038 | | Number of Individuals Covered | 3731 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,381 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DBL, TDB, PAID FAMILY LEAVE | | Welfare Benefit Premiums Paid to Carrier | USD $1,315,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,381 | | 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 | 3335306 |
| Policy instance | 2 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 796 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $63,632 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $101,694 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,632 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 418202 |
| Policy instance | 6 |
| Insurance contract or identification number | 418202 | | Number of Individuals Covered | 1545 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $14,532 | | Total amount of fees paid to insurance company | USD $8,165 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $810,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,532 | | Amount paid for insurance broker fees | 8165 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 418210 |
| Policy instance | 5 |
| Insurance contract or identification number | 418210 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of fees paid to insurance company | USD $12 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 418201 |
| Policy instance | 4 |
| Insurance contract or identification number | 418201 | | Number of Individuals Covered | 2535 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $4,416 | | Total amount of fees paid to insurance company | USD $6,206 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $512,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,416 | | Amount paid for insurance broker fees | 6206 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 3 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2514 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,105 | | Total amount of fees paid to insurance company | USD $1,883 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $207,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,105 | | Amount paid for insurance broker fees | 1883 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 1 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 3031 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $106,202 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $106,202 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012530-000 |
| Policy instance | 7 |
| Insurance contract or identification number | 16-012530-000 | | Number of Individuals Covered | 1871 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $4,021 | | Welfare Benefit Premiums Paid to Carrier | USD $35,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 4021 | | Insurance broker organization code? | 3 | | Insurance broker name | STEALTH BENEFIT SOLUTIONS LLC |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 418463 |
| Policy instance | 10 |
| Insurance contract or identification number | 418463 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Welfare Benefit Premiums Paid to Carrier | USD $5,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 3 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,315 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,315 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 4166 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UTH25920 |
| Policy instance | 2 |
| Insurance contract or identification number | UTH25920 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,908 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,908 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 418202 |
| Policy instance | 9 |
| Insurance contract or identification number | 418202 | | Number of Individuals Covered | 1377 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $19,115 | | Total amount of fees paid to insurance company | USD $15,288 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $611,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,115 | | Amount paid for insurance broker fees | 15288 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) |
| Policy contract number | 418210 |
| Policy instance | 8 |
| Insurance contract or identification number | 418210 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of fees paid to insurance company | USD $17 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 17 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 418201 |
| Policy instance | 7 |
| Insurance contract or identification number | 418201 | | Number of Individuals Covered | 2302 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $8,151 | | Total amount of fees paid to insurance company | USD $7,164 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $373,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,151 | | Amount paid for insurance broker fees | 7164 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 6 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2395 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $6,508 | | Total amount of fees paid to insurance company | USD $1,428 | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LASIK | | Welfare Benefit Premiums Paid to Carrier | USD $216,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,508 | | Amount paid for insurance broker fees | 1428 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335306 |
| Policy instance | 5 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $92,095 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $92,095 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 4 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 2945 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 4059 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | UT00105U |
| Policy instance | 2 |
| Insurance contract or identification number | UT00105U | | Number of Individuals Covered | 2174 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,668 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,668 | | Insurance broker name | SCOTT T BUIE |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UTH25920 |
| Policy instance | 3 |
| Insurance contract or identification number | UTH25920 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,040 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,884 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,040 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 4 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,011 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,643 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,011 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751003 |
| Policy instance | 5 |
| Insurance contract or identification number | G10065751003 | | Number of Individuals Covered | 2791 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 name | DIVERSIFIED INSURANCE BENEFIT |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335306 |
| Policy instance | 7 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 496 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision 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 | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 8 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 2199 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 9 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2244 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,023 | | Total amount of fees paid to insurance company | USD $1,918 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $167,450 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,023 | | Amount paid for insurance broker fees | 1918 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 6 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 2138 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $17,400 | | Life 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 $3,275 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT T BUIE |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 9 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2002 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,877 | | Total amount of fees paid to insurance company | USD $1,008 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $162,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,877 | | Amount paid for insurance broker fees | 1008 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 8 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 2169 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3335306 |
| Policy instance | 7 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 458 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,448 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,554,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,448 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 6 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 2021 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,646 | | Life 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 $3,019 | | Insurance broker organization code? | 3 | | Insurance broker name | ISAAC BUIE |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751002 |
| Policy instance | 5 |
| Insurance contract or identification number | G10065751002 | | Number of Individuals Covered | 2647 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $73,892 | | Total amount of fees paid to insurance company | USD $25,123 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,947,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73,892 | | Amount paid for insurance broker fees | 25123 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 4 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,350 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,350 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 3919 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | UTH25920 |
| Policy instance | 3 |
| Insurance contract or identification number | UTH25920 | | Number of Individuals Covered | 246 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,228 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,228 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | UT00105U |
| Policy instance | 2 |
| Insurance contract or identification number | UT00105U | | Number of Individuals Covered | 2028 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,702 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,702 | | Insurance broker name | SCOTT T BUIE |
|
| ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 10 |
| Number of Individuals Covered | 990 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | WELLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $238,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ORRIANT, LLC (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | |
| Policy instance | 10 |
| Number of Individuals Covered | 880 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $291,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010350721 |
| Policy instance | 9 |
| Insurance contract or identification number | 010350721 | | Number of Individuals Covered | 2024 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,651 | | Total amount of fees paid to insurance company | USD $672 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $121,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,651 | | Amount paid for insurance broker fees | 672 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 8 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 1956 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Long Term Disability 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 | 3335306 |
| Policy instance | 7 |
| Insurance contract or identification number | 3335306 | | Number of Individuals Covered | 338 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $22,849 | | Total amount of fees paid to insurance company | USD $10,050 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,054,869 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,849 | | Amount paid for insurance broker fees | 10050 | | Insurance broker organization code? | 3 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751002 |
| Policy instance | 5 |
| Insurance contract or identification number | G10065751002 | | Number of Individuals Covered | 2719 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $59,668 | | Total amount of fees paid to insurance company | USD $20,287 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,000,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,668 | | Amount paid for insurance broker fees | 20287 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 6 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 1822 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,120 | | Life 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 $2,907 | | Insurance broker organization code? | 3 | | Insurance broker name | ISAAC BUIE |
|
| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 4 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 252 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,907 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,907 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 661 |
| Policy instance | 3 |
| Insurance contract or identification number | 661 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,565 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,565 | | Insurance broker name | DIVERSIFIED INSURANCE |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | UT00105U |
| Policy instance | 2 |
| Insurance contract or identification number | UT00105U | | Number of Individuals Covered | 1872 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,593 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,593 | | Insurance broker name | SCOTT T BUIE |
|
| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 3654 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 6 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 1751 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,349 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 8 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 1830 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes |
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| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 4 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,902 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,781 |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 661 |
| Policy instance | 3 |
| Insurance contract or identification number | 661 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,339 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $27,095 |
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| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | UT00105U |
| Policy instance | 2 |
| Insurance contract or identification number | UT00105U | | Number of Individuals Covered | 1748 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,763 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,430 |
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| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 3586 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751002 |
| Policy instance | 5 |
| Insurance contract or identification number | G10065751002 | | Number of Individuals Covered | 2671 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $58,946 | | Total amount of fees paid to insurance company | USD $23,111 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,894,922 |
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| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G1006575T001 |
| Policy instance | 7 |
| Insurance contract or identification number | G1006575T001 | | Number of Individuals Covered | 694 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $24,476 | | Total amount of fees paid to insurance company | USD $9,596 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,447,578 |
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| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 150860 |
| Policy instance | 7 |
| Insurance contract or identification number | 150860 | | Number of Individuals Covered | 1657 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $7,420 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $1,753 | | Insurance broker name | ISAAC BUIE |
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| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G10065751002 |
| Policy instance | 6 |
| Insurance contract or identification number | G10065751002 | | Number of Individuals Covered | 2384 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $53,797 | | Total amount of fees paid to insurance company | USD $17,364 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,664,465 | | Commission paid to Insurance Broker | USD $53,797 | | Amount paid for insurance broker fees | 17364 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 661 |
| Policy instance | 4 |
| Insurance contract or identification number | 661 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,390 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,435 | | Commission paid to Insurance Broker | USD $6,390 | | Insurance broker name | DIVERSIFIED INSURANCE |
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| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 63533-2 |
| Policy instance | 3 |
| Insurance contract or identification number | 63533-2 | | Number of Individuals Covered | 1306 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $246,456 |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | UT00105U |
| Policy instance | 2 |
| Insurance contract or identification number | UT00105U | | Number of Individuals Covered | 1657 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,925 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,013 | | Commission paid to Insurance Broker | USD $4,925 | | Insurance broker name | SCOTT T BUIE |
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| TOTAL DENTAL ADMINISTRATORS OF UTAH,, INC. (National Association of Insurance Commissioners NAIC id number: 11560 ) |
| Policy contract number | 422350 |
| Policy instance | 5 |
| Insurance contract or identification number | 422350 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,230 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,034 | | Commission paid to Insurance Broker | USD $1,230 | | Insurance broker name | DIVERSIFIED INSURANCE |
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| REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 ) |
| Policy contract number | 10007537 |
| Policy instance | 1 |
| Insurance contract or identification number | 10007537 | | Number of Individuals Covered | 3264 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G1006575T001 |
| Policy instance | 8 |
| Insurance contract or identification number | G1006575T001 | | Number of Individuals Covered | 648 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $19,902 | | Total amount of fees paid to insurance company | USD $6,424 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,080,918 | | Commission paid to Insurance Broker | USD $19,902 | | Amount paid for insurance broker fees | 6424 | | Insurance broker name | DIVERSIFIED INSURANCE BENEFIT SERVI |
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