HOLMAN DISTRIBUTION CENTER OF WASHINGTON INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HOLMAN DISTRIBUTION WELFARE PLAN
Measure | Date | Value |
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2022: HOLMAN DISTRIBUTION WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 676 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 882 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
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 | 882 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: HOLMAN DISTRIBUTION WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 610 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 674 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 676 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: HOLMAN DISTRIBUTION WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 595 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 606 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 608 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: HOLMAN DISTRIBUTION WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 687 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 595 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 595 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: HOLMAN DISTRIBUTION WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 698 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 680 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 687 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: HOLMAN DISTRIBUTION WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 479 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 622 |
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 | 0 |
Total of all active and inactive participants | 2017-01-01 | 622 |
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 93893 |
Policy instance | 6 |
Insurance contract or identification number | 93893 | Number of Individuals Covered | 1130 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $118,659 | Total amount of fees paid to insurance company | USD $11,260 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $732,436 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $108,476 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
Policy contract number | 474378 |
Policy instance | 5 |
Insurance contract or identification number | 474378 | Number of Individuals Covered | 294 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,535 | Total amount of fees paid to insurance company | USD $219 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $42,151 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,008 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948767 |
Policy instance | 4 |
Insurance contract or identification number | 5948767 | Number of Individuals Covered | 1731 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $27,037 | Total amount of fees paid to insurance company | USD $6,299 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $375,958 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,037 | Amount paid for insurance broker fees | 63 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | EAP |
Policy instance | 3 |
Insurance contract or identification number | EAP | Number of Individuals Covered | 882 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $19,303 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 913458 |
Policy instance | 2 |
Insurance contract or identification number | 913458 | Number of Individuals Covered | 895 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $-64,930 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30002111 |
Policy instance | 1 |
Insurance contract or identification number | 30002111 | Number of Individuals Covered | 830 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,428 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $77,101 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,425 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30002111 |
Policy instance | 1 |
Insurance contract or identification number | 30002111 | Number of Individuals Covered | 753 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,357 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,943 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,159 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 913458 |
Policy instance | 2 |
Insurance contract or identification number | 913458 | Number of Individuals Covered | 769 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,805,832 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | EAP |
Policy instance | 3 |
Insurance contract or identification number | EAP | Number of Individuals Covered | 832 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $18,622 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948767 |
Policy instance | 4 |
Insurance contract or identification number | 5948767 | Number of Individuals Covered | 1620 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $31,872 | Total amount of fees paid to insurance company | USD $6,250 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $430,358 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31,872 | Amount paid for insurance broker fees | 54 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
Policy contract number | 474378 |
Policy instance | 5 |
Insurance contract or identification number | 474378 | Number of Individuals Covered | 244 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,240 | Total amount of fees paid to insurance company | USD $561 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $41,346 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,240 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 93893 |
Policy instance | 6 |
Insurance contract or identification number | 93893 | Number of Individuals Covered | 840 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $117,025 | Total amount of fees paid to insurance company | USD $11,600 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $987,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $117,025 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 93893 |
Policy instance | 6 |
Insurance contract or identification number | 93893 | Number of Individuals Covered | 820 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $120,878 | Total amount of fees paid to insurance company | USD $14,222 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,ACCIDENT, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $629,814 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $120,878 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) |
Policy contract number | 474378 |
Policy instance | 5 |
Insurance contract or identification number | 474378 | Number of Individuals Covered | 267 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,198 | Total amount of fees paid to insurance company | USD $998 | Other welfare benefits provided | CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $39,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,198 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948767 |
Policy instance | 4 |
Insurance contract or identification number | 5948767 | Number of Individuals Covered | 1582 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $30,259 | Total amount of fees paid to insurance company | USD $5,759 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $348,143 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,259 | Amount paid for insurance broker fees | 41 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | EAP |
Policy instance | 3 |
Insurance contract or identification number | EAP | Number of Individuals Covered | 819 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $17,026 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 913458 |
Policy instance | 2 |
Insurance contract or identification number | 913458 | Number of Individuals Covered | 746 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,820,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30002111 |
Policy instance | 1 |
Insurance contract or identification number | 30002111 | 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 $2,451 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $90,597 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,451 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30002111 |
Policy instance | 1 |
Insurance contract or identification number | 30002111 | Number of Individuals Covered | 468 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,512 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,557 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,512 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 913458 |
Policy instance | 2 |
Insurance contract or identification number | 913458 | Number of Individuals Covered | 455 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,465,688 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | EAP |
Policy instance | 3 |
Insurance contract or identification number | EAP | Number of Individuals Covered | 579 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $12,309 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948767 |
Policy instance | 4 |
Insurance contract or identification number | 5948767 | Number of Individuals Covered | 1274 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $24,227 | Total amount of fees paid to insurance company | USD $3,740 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $303,277 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,227 | Amount paid for insurance broker fees | 43 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 93893 |
Policy instance | 5 |
Insurance contract or identification number | 93893 | Number of Individuals Covered | 567 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $51,223 | Total amount of fees paid to insurance company | USD $4,353 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $348,267 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $51,223 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 227262 |
Policy instance | 2 |
Insurance contract or identification number | 227262 | Number of Individuals Covered | 59 | Insurance policy start date | 2016-09-01 | Insurance policy end date | 2017-08-31 | Total amount of commissions paid to insurance broker | USD $11,617 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $217,544 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,650 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 02W4839 |
Policy instance | 3 |
Insurance contract or identification number | 02W4839 | Number of Individuals Covered | 399 | Insurance policy start date | 2016-06-01 | Insurance policy end date | 2017-05-31 | Total amount of commissions paid to insurance broker | USD $47,488 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,725,501 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $47,488 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | JOHN JOSEPH DAVIDSON |
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BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
Policy contract number | 65-23898 |
Policy instance | 4 |
Insurance contract or identification number | 65-23898 | Number of Individuals Covered | 15 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $5,093 | Total amount of fees paid to insurance company | USD $0 | 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 $5,093 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BRIAN STRITT |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05750852 |
Policy instance | 5 |
Insurance contract or identification number | KM05750852 | Number of Individuals Covered | 1462 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $23,141 | Total amount of fees paid to insurance company | USD $3,355 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $288,787 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,881 | Amount paid for insurance broker fees | 64 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INSURANCE |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 910952 |
Policy instance | 6 |
Insurance contract or identification number | 910952 | Number of Individuals Covered | 81 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1 | Total amount of fees paid to insurance company | USD $10,285 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $337,106 | 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 | 6122 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | JOHN JOSEPH DAVIDSON |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 909215 |
Policy instance | 7 |
Insurance contract or identification number | 909215 | Number of Individuals Covered | 43 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,897 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $93,760 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,897 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 93893 |
Policy instance | 8 |
Insurance contract or identification number | 93893 | Number of Individuals Covered | 248 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $12,731 | Total amount of fees paid to insurance company | USD $1,157 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $114,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,365 | Amount paid for insurance broker fees | 545 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 30002111 |
Policy instance | 1 |
Insurance contract or identification number | 30002111 | Number of Individuals Covered | 612 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,590 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $58,783 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,281 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | WELLS FARGO INSURANCE |
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