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AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameAFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN
Plan identification number 501

AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

AFOGNAK NATIVE CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:AFOGNAK NATIVE CORPORATION
Employer identification number (EIN):920047145
NAIC Classification:561490

Additional information about AFOGNAK NATIVE CORPORATION

Jurisdiction of Incorporation: Alaska Department Commerce, Community & Economic Development
Incorporation Date: 1973-06-18
Company Identification Number: 12040D
Legal Registered Office Address: 3909 ARCTIC BLVD STE 500

ANCHORAGE
United States of America (USA)
99503

More information about AFOGNAK NATIVE CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01PATRICIA WATSON2023-08-30
5012021-01-01PATRICIA WATSON2022-08-03
5012020-01-01PATRICIA WATSON2021-07-28
5012019-01-01PATRICIA WATSON2020-07-17
5012018-01-01PATRICIA WATSON2019-09-24
5012017-01-01

Plan Statistics for AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN

401k plan membership statisitcs for AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN

Measure Date Value
2022: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-012,856
Total number of active participants reported on line 7a of the Form 55002022-01-013,156
Number of retired or separated participants receiving benefits2022-01-0124
Total of all active and inactive participants2022-01-013,180
2021: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-013,048
Total number of active participants reported on line 7a of the Form 55002021-01-012,838
Number of retired or separated participants receiving benefits2021-01-0118
Total of all active and inactive participants2021-01-012,856
2020: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-013,356
Total number of active participants reported on line 7a of the Form 55002020-01-013,048
Number of retired or separated participants receiving benefits2020-01-010
Total of all active and inactive participants2020-01-013,048
2019: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-014,406
Total number of active participants reported on line 7a of the Form 55002019-01-013,356
Number of retired or separated participants receiving benefits2019-01-010
Total of all active and inactive participants2019-01-013,356
2018: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-013,387
Total number of active participants reported on line 7a of the Form 55002018-01-014,394
Number of retired or separated participants receiving benefits2018-01-0112
Total of all active and inactive participants2018-01-014,406
2017: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,648
Total number of active participants reported on line 7a of the Form 55002017-01-013,375
Number of retired or separated participants receiving benefits2017-01-0112
Total of all active and inactive participants2017-01-013,387

Financial Data on AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN

Measure Date Value
2022 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$3,273,535
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$3,702,135
Total income from all sources (including contributions)2022-12-31$23,416,525
Total of all expenses incurred2022-12-31$22,404,720
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$21,190,169
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$23,150,005
Value of total assets at end of year2022-12-31$5,427,072
Value of total assets at beginning of year2022-12-31$4,843,867
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$1,214,551
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$33,850
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$5,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$5,720,947
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$90,036
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$113,867
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$573,481
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$3,273,535
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$3,702,135
Other income not declared elsewhere2022-12-31$266,520
Administrative expenses (other) incurred2022-12-31$1,180,701
Total non interest bearing cash at end of year2022-12-31$3,060,480
Total non interest bearing cash at beginning of year2022-12-31$1,925,084
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$1,011,805
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,153,537
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,141,732
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$9,127,777
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$17,339,022
Employer contributions (assets) at end of year2022-12-31$2,252,725
Employer contributions (assets) at beginning of year2022-12-31$2,345,302
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$12,062,392
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CITRIN COOPERMAN & COMPANY, LLP
Accountancy firm EIN2022-12-31222428965
2021 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$3,702,135
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$3,832,344
Total income from all sources (including contributions)2021-12-31$24,465,537
Total of all expenses incurred2021-12-31$23,397,661
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$22,214,740
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$24,371,612
Value of total assets at end of year2021-12-31$4,843,867
Value of total assets at beginning of year2021-12-31$3,906,200
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,182,921
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$31,000
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$5,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$6,001,584
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$135,817
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$573,481
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$3,702,135
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$3,832,344
Other income not declared elsewhere2021-12-31$93,925
Administrative expenses (other) incurred2021-12-31$1,151,921
Total non interest bearing cash at end of year2021-12-31$1,925,084
Total non interest bearing cash at beginning of year2021-12-31$1,271,476
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,067,876
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,141,732
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$73,856
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$9,702,718
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$18,234,211
Employer contributions (assets) at end of year2021-12-31$2,345,302
Employer contributions (assets) at beginning of year2021-12-31$2,634,724
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$12,512,022
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CITRIN COOPERMAN & COMPANY, LLP
Accountancy firm EIN2021-12-31222428965
2020 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$3,832,344
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$4,037,192
Total income from all sources (including contributions)2020-12-31$27,431,553
Total of all expenses incurred2020-12-31$27,059,606
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$25,542,276
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$27,431,553
Value of total assets at end of year2020-12-31$3,906,200
Value of total assets at beginning of year2020-12-31$3,739,101
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,517,330
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$30,066
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$2,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$6,289,053
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$120,884
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$107,817
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$3,832,344
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$4,037,192
Administrative expenses (other) incurred2020-12-31$1,487,264
Total non interest bearing cash at end of year2020-12-31$1,271,476
Total non interest bearing cash at beginning of year2020-12-31$1,082,897
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$371,947
Value of net assets at end of year (total assets less liabilities)2020-12-31$73,856
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$-298,091
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$8,010,100
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$21,021,616
Employer contributions (assets) at end of year2020-12-31$2,634,724
Employer contributions (assets) at beginning of year2020-12-31$2,656,204
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$17,424,359
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31CITRIN COOPERMAN & COMPANY, LLP
Accountancy firm EIN2020-12-31222428965
2019 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$4,037,192
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$3,381,176
Total income from all sources (including contributions)2019-12-31$24,649,453
Total of all expenses incurred2019-12-31$27,441,613
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$25,930,666
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$24,515,408
Value of total assets at end of year2019-12-31$3,739,101
Value of total assets at beginning of year2019-12-31$5,875,245
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,510,947
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$28,118
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$5,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$5,738,261
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$68,514
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$373,594
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$4,037,192
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$3,381,176
Other income not declared elsewhere2019-12-31$134,045
Administrative expenses (other) incurred2019-12-31$1,482,829
Total non interest bearing cash at end of year2019-12-31$1,082,897
Total non interest bearing cash at beginning of year2019-12-31$3,595,299
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-2,792,160
Value of net assets at end of year (total assets less liabilities)2019-12-31$-298,091
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$2,494,069
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$6,773,750
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$18,708,633
Employer contributions (assets) at end of year2019-12-31$2,656,204
Employer contributions (assets) at beginning of year2019-12-31$2,279,946
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$18,783,322
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31HOMES, LOWRY, HORN & JOHNSON, LTD.
Accountancy firm EIN2019-12-31540975470
2018 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$3,381,176
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$2,370,042
Total income from all sources (including contributions)2018-12-31$20,770,181
Total of all expenses incurred2018-12-31$22,240,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$20,840,574
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$20,770,181
Value of total assets at end of year2018-12-31$5,875,245
Value of total assets at beginning of year2018-12-31$6,334,519
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$1,400,015
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$29,684
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$5,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$5,373,523
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$78,668
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$88,485
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$3,381,176
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$2,370,042
Administrative expenses (other) incurred2018-12-31$1,370,331
Total non interest bearing cash at end of year2018-12-31$3,595,299
Total non interest bearing cash at beginning of year2018-12-31$6,210,769
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-1,470,408
Value of net assets at end of year (total assets less liabilities)2018-12-31$2,494,069
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$3,964,477
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$5,405,601
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$15,317,990
Employer contributions (assets) at end of year2018-12-31$2,279,946
Employer contributions (assets) at beginning of year2018-12-31$123,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$15,346,488
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31HOMES, LOWRY, HORN & JOHNSON, LTD.
Accountancy firm EIN2018-12-31540975470
2017 : AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$2,370,042
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$2,955,467
Total income from all sources (including contributions)2017-12-31$21,446,600
Total of all expenses incurred2017-12-31$19,191,219
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$17,857,080
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$21,324,514
Value of total assets at end of year2017-12-31$6,334,519
Value of total assets at beginning of year2017-12-31$4,664,563
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$1,334,139
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$35,961
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$4,963,451
Participant contributions at beginning of year2017-12-31$370,698
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$88,135
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$2,370,042
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$2,955,467
Other income not declared elsewhere2017-12-31$122,086
Administrative expenses (other) incurred2017-12-31$1,298,178
Total non interest bearing cash at end of year2017-12-31$6,210,769
Total non interest bearing cash at beginning of year2017-12-31$2,507,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$2,255,381
Value of net assets at end of year (total assets less liabilities)2017-12-31$3,964,477
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,709,096
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$4,704,146
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$16,272,928
Employer contributions (assets) at end of year2017-12-31$123,750
Employer contributions (assets) at beginning of year2017-12-31$1,785,944
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$13,152,934
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31HOMES, LOWRY, HORN & JOHNSON, LTD.
Accountancy firm EIN2017-12-31540975470

Form 5500 Responses for AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN

2022: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: AFOGNAK NATIVE CORPORATION HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 6
Insurance contract or identification number681004G
Number of Individuals Covered2193
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,644
Total amount of fees paid to insurance companyUSD $614
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $25,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,644
Amount paid for insurance broker fees614
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU5466336
Policy instance 18
Insurance contract or identification numberGTU5466336
Number of Individuals Covered440
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,636
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 number16-011032-000
Policy instance 1
Insurance contract or identification number16-011032-000
Number of Individuals Covered1298
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10,733
Welfare Benefit Premiums Paid to CarrierUSD $843,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees10733
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 2
Insurance contract or identification number9260109
Number of Individuals Covered226
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,125
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $58,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees670
Additional information about fees paid to insurance brokerTPA ADMIN FEES
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 3
Insurance contract or identification number94162
Number of Individuals Covered9
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 4
Insurance contract or identification number0165999
Number of Individuals Covered921
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $887
Total amount of fees paid to insurance companyUSD $3,653
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $176,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $887
Amount paid for insurance broker fees3653
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 5
Insurance contract or identification number0165998
Number of Individuals Covered1138
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $511
Total amount of fees paid to insurance companyUSD $2,016
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $511
Amount paid for insurance broker fees2016
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 7
Insurance contract or identification number681004G
Number of Individuals Covered1321
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,782
Total amount of fees paid to insurance companyUSD $1,411
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $58,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,782
Amount paid for insurance broker fees1411
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 8
Insurance contract or identification number681004G
Number of Individuals Covered2193
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,471
Total amount of fees paid to insurance companyUSD $8,386
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $349,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,471
Amount paid for insurance broker fees8386
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 9
Insurance contract or identification number681004G
Number of Individuals Covered539
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,532
Total amount of fees paid to insurance companyUSD $2,064
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $85,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,532
Amount paid for insurance broker fees2064
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 10
Insurance contract or identification number681004G
Number of Individuals Covered809
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $22,647
Total amount of fees paid to insurance companyUSD $8,452
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $351,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,647
Amount paid for insurance broker fees8452
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 )
Policy contract numberAXHX5376
Policy instance 17
Insurance contract or identification numberAXHX5376
Number of Individuals Covered64
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,158
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $907,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3132
Additional information about fees paid to insurance brokerPREFERRED PRODUCER PROGRAM
Insurance broker organization code?3
PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 )
Policy contract numberAXPX5259
Policy instance 16
Insurance contract or identification numberAXPX5259
Number of Individuals Covered84
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8,065
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,761,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees6076
Additional information about fees paid to insurance brokerPREFERRED PRODUCER PROGRAM
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number07557A
Policy instance 15
Insurance contract or identification number07557A
Number of Individuals Covered142
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $83,750
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $2,093,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees83750
Additional information about fees paid to insurance brokerSALES & SERVICES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number2004047
Policy instance 14
Insurance contract or identification number2004047
Number of Individuals Covered1298
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $139,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216636
Policy instance 13
Insurance contract or identification number0216636
Number of Individuals Covered2562
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $37,559
Total amount of fees paid to insurance companyUSD $117
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,248,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,559
Amount paid for insurance broker fees89
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered2192
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,115
Total amount of fees paid to insurance companyUSD $1,536
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $63,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,115
Amount paid for insurance broker fees1536
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered2166
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $42,189
Total amount of fees paid to insurance companyUSD $15,746
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $655,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,189
Amount paid for insurance broker fees15746
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 8
Insurance contract or identification number681004G
Number of Individuals Covered2257
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $16,577
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $314,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,931
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 7
Insurance contract or identification number681004G
Number of Individuals Covered1430
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,552
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $48,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,529
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 6
Insurance contract or identification number681004G
Number of Individuals Covered2257
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,210
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $22,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $725
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 5
Insurance contract or identification number0165998
Number of Individuals Covered1247
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,533
Total amount of fees paid to insurance companyUSD $2,051
Health Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $101,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,533
Amount paid for insurance broker fees2051
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 4
Insurance contract or identification number0165999
Number of Individuals Covered958
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $23,719
Total amount of fees paid to insurance companyUSD $2,624
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $198,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,719
Amount paid for insurance broker fees2624
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND MARKETING FEES
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 3
Insurance contract or identification number94162
Number of Individuals Covered46
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $449,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 2
Insurance contract or identification number9260109
Number of Individuals Covered282
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,285
Total amount of fees paid to insurance companyUSD $814
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $62,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,285
Amount paid for insurance broker fees57
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-011032-000
Policy instance 1
Insurance contract or identification number16-011032-000
Number of Individuals Covered1399
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $26,825
Welfare Benefit Premiums Paid to CarrierUSD $900,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees24194
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 9
Insurance contract or identification number681004G
Number of Individuals Covered604
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,624
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $68,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,171
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 10
Insurance contract or identification number681004G
Number of Individuals Covered892
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $16,092
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $305,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,640
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered2225
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $18,847
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $357,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,290
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU5466336
Policy instance 18
Insurance contract or identification numberGTU5466336
Number of Individuals Covered440
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 )
Policy contract numberAXHX5376
Policy instance 17
Insurance contract or identification numberAXHX5376
Number of Individuals Covered68
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $915,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 )
Policy contract numberAXPX5259
Policy instance 16
Insurance contract or identification numberAXPX5259
Number of Individuals Covered84
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,570,997
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 number07557A
Policy instance 15
Insurance contract or identification number07557A
Number of Individuals Covered189
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $100,846
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $2,371,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100,846
Additional information about fees paid to insurance brokerSALES & SERVICES
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417007412280
Policy instance 14
Insurance contract or identification number417007412280
Number of Individuals Covered1399
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $126,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216636
Policy instance 13
Insurance contract or identification number0216636
Number of Individuals Covered2721
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $39,165
Total amount of fees paid to insurance companyUSD $57
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,270,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,165
Amount paid for insurance broker fees57
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered2224
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $30,540
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $579,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,295
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 9
Insurance contract or identification number681004G
Number of Individuals Covered2912
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $36,152
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $451,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,713
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 8
Insurance contract or identification number681004G
Number of Individuals Covered1868
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,016
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $62,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,400
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 7
Insurance contract or identification number681004G
Number of Individuals Covered2912
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,610
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $32,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,290
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 6
Insurance contract or identification number0165998
Number of Individuals Covered1536
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $37,330
Total amount of fees paid to insurance companyUSD $1,779
Health Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $130,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,330
Amount paid for insurance broker fees1779
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 5
Insurance contract or identification number0165999
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $52,590
Total amount of fees paid to insurance companyUSD $2,569
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $192,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,590
Amount paid for insurance broker fees2569
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND MARKETING FEES
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 4
Insurance contract or identification number94162
Number of Individuals Covered52
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $618,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 10
Insurance contract or identification number681004G
Number of Individuals Covered779
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,550
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $94,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,623
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered1206
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $32,490
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $405,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,501
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered2879
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $64,776
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $809,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,823
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 13
Insurance contract or identification number681004G
Number of Individuals Covered2879
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $42,078
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $525,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,912
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS PAID
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number07557A
Policy instance 14
Insurance contract or identification number07557A
Number of Individuals Covered23
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $10,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417007412280
Policy instance 16
Insurance contract or identification number417007412280
Number of Individuals Covered1782
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $164,844
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 number07557A
Policy instance 17
Insurance contract or identification number07557A
Number of Individuals Covered190
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $149,457
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $2,135,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $149,457
Additional information about fees paid to insurance brokerSALES & SERVICES
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number07557B001
Policy instance 18
Insurance contract or identification number07557B001
Number of Individuals Covered1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedMEDICAL BENEFITS ABROAD COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $36,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 3
Insurance contract or identification number9260109
Number of Individuals Covered295
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,761
Total amount of fees paid to insurance companyUSD $1,229
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $67,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,670
Insurance broker organization code?3
Amount paid for insurance broker fees789
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0302893
Policy instance 2
Insurance contract or identification numberR0302893
Number of Individuals Covered24
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $516
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGCIEE, GRPACCVO, GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $6,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $380
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216636
Policy instance 15
Insurance contract or identification number0216636
Number of Individuals Covered3320
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $44,013
Total amount of fees paid to insurance companyUSD $31
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,445,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,013
Amount paid for insurance broker fees31
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-011032-000
Policy instance 1
Insurance contract or identification number16-011032-000
Number of Individuals Covered1855
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $-15
Total amount of fees paid to insurance companyUSD $38,429
Welfare Benefit Premiums Paid to CarrierUSD $1,002,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-15
Amount paid for insurance broker fees19092
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417007412280
Policy instance 16
Insurance contract or identification number417007412280
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $135,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0006865070
Policy instance 17
Insurance contract or identification number0006865070
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13
Total amount of fees paid to insurance companyUSD $450
Other welfare benefits providedISWL STND
Welfare Benefit Premiums Paid to CarrierUSD $260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10
Amount paid for insurance broker fees450
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number07557A
Policy instance 14
Insurance contract or identification number07557A
Number of Individuals Covered154
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $88,041
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $1,257,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,330
Additional information about fees paid to insurance brokerSALES & SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered2879
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $49,284
Total amount of fees paid to insurance companyUSD $6,571
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $613,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,921
Insurance broker organization code?3
Amount paid for insurance broker fees6571
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered1174
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $24,657
Total amount of fees paid to insurance companyUSD $3,287
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $306,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,971
Insurance broker organization code?3
Amount paid for insurance broker fees3287
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 10
Insurance contract or identification number681004G
Number of Individuals Covered792
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,869
Total amount of fees paid to insurance companyUSD $783
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $73,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,039
Insurance broker organization code?3
Amount paid for insurance broker fees783
Additional information about fees paid to insurance brokerBONUS PAID
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 13
Insurance contract or identification number681004G
Number of Individuals Covered2879
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $43,235
Total amount of fees paid to insurance companyUSD $5,764
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $538,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,758
Insurance broker organization code?3
Amount paid for insurance broker fees5764
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 7
Insurance contract or identification number681004G
Number of Individuals Covered2934
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,216
Total amount of fees paid to insurance companyUSD $296
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $27,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,525
Insurance broker organization code?3
Amount paid for insurance broker fees296
Additional information about fees paid to insurance brokerBONUS PAID
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 6
Insurance contract or identification number0165998
Number of Individuals Covered1839
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $47,529
Total amount of fees paid to insurance companyUSD $1,010
Health Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $140,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,529
Amount paid for insurance broker fees1010
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND MARKETING FEES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 8
Insurance contract or identification number681004G
Number of Individuals Covered1865
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,135
Total amount of fees paid to insurance companyUSD $551
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $51,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,846
Insurance broker organization code?3
Amount paid for insurance broker fees551
Additional information about fees paid to insurance brokerBONUS PAID
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-011032-000
Policy instance 1
Insurance contract or identification number16-011032-000
Number of Individuals Covered2006
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $24,614
Total amount of fees paid to insurance companyUSD $23,322
Welfare Benefit Premiums Paid to CarrierUSD $976,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,614
Amount paid for insurance broker fees12367
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0302893
Policy instance 2
Insurance contract or identification numberR0302893
Number of Individuals Covered24
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $521
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGCIEE, GRPACCVO, GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $7,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $384
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 3
Insurance contract or identification number9260109
Number of Individuals Covered298
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,866
Total amount of fees paid to insurance companyUSD $379
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $58,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,330
Amount paid for insurance broker fees379
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 9
Insurance contract or identification number681004G
Number of Individuals Covered2934
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $30,361
Total amount of fees paid to insurance companyUSD $4,048
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $377,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,897
Insurance broker organization code?3
Amount paid for insurance broker fees4048
Additional information about fees paid to insurance brokerBONUS PAID
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 4
Insurance contract or identification number94162
Number of Individuals Covered64
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $597,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 5
Insurance contract or identification number0165999
Number of Individuals Covered909
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $69,006
Total amount of fees paid to insurance companyUSD $1,375
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $193,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,006
Amount paid for insurance broker fees1375
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND MARKETING FEES
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0216636
Policy instance 15
Insurance contract or identification number0216636
Number of Individuals Covered5333
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $20,887
Total amount of fees paid to insurance companyUSD $41
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,428,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,887
Amount paid for insurance broker fees41
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered945
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,884
Total amount of fees paid to insurance companyUSD $710
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $58,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,884
Amount paid for insurance broker fees710
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16011032000
Policy instance 1
Insurance contract or identification number16011032000
Number of Individuals Covered1687
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $101,252
Total amount of fees paid to insurance companyUSD $29,996
Welfare Benefit Premiums Paid to CarrierUSD $1,012,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101,252
Amount paid for insurance broker fees29996
Additional information about fees paid to insurance brokerGROUP 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 number07557A
Policy instance 15
Insurance contract or identification number07557A
Number of Individuals Covered80
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $68,263
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Other welfare benefits providedEVACUATION COVERAGE
Welfare Benefit Premiums Paid to CarrierUSD $975,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,263
Additional information about fees paid to insurance brokerSALES AND SERVICES
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 14
Insurance contract or identification number681004G
Number of Individuals Covered2654
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $35,242
Total amount of fees paid to insurance companyUSD $5,126
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $425,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,242
Amount paid for insurance broker fees5126
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 13
Insurance contract or identification number681004G
Number of Individuals Covered2692
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $38,888
Total amount of fees paid to insurance companyUSD $5,656
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $469,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,888
Amount paid for insurance broker fees5656
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered60
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $20,877
Total amount of fees paid to insurance companyUSD $3,037
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $252,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,877
Amount paid for insurance broker fees3037
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 10
Insurance contract or identification number681004G
Number of Individuals Covered2692
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,518
Total amount of fees paid to insurance companyUSD $2,257
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $187,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,518
Amount paid for insurance broker fees2257
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 9
Insurance contract or identification number681004G
Number of Individuals Covered1757
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,649
Total amount of fees paid to insurance companyUSD $531
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $44,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,649
Amount paid for insurance broker fees531
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 8
Insurance contract or identification number681004G
Number of Individuals Covered2692
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,254
Total amount of fees paid to insurance companyUSD $183
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $15,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,254
Amount paid for insurance broker fees183
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 7
Insurance contract or identification number0165998
Number of Individuals Covered1428
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $119,579
Total amount of fees paid to insurance companyUSD $9,371
Health Insurance Welfare BenefitYes
Other welfare benefits providedGROUP ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $133,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119,579
Amount paid for insurance broker fees9371
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 5
Insurance contract or identification number94162
Number of Individuals Covered62
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $513,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 6
Insurance contract or identification number0165999
Number of Individuals Covered1039
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $125,614
Total amount of fees paid to insurance companyUSD $9,641
Health Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $152,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125,614
Amount paid for insurance broker fees9641
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION AND NON-MONETARY COMPENSATION
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115272
Policy instance 4
Insurance contract or identification number115272
Number of Individuals Covered133
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $21,900
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $742,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,900
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 3
Insurance contract or identification number9260109
Number of Individuals Covered223
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,188
Total amount of fees paid to insurance companyUSD $1,113
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $51,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,188
Amount paid for insurance broker fees1113
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0302893
Policy instance 2
Insurance contract or identification numberR0302893
Number of Individuals Covered30
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $664
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedGCIEE, GRPACCVO, GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $8,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $487
Insurance broker organization code?3
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number94162
Policy instance 8
Insurance contract or identification number94162
Number of Individuals Covered47
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $360,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract number49404
Policy instance 7
Insurance contract or identification number49404
Number of Individuals Covered2
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $50
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedDISABILITY INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFIT SYSTEMS
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115272
Policy instance 6
Insurance contract or identification number115272
Number of Individuals Covered127
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $28,440
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $951,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,440
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number9260109
Policy instance 5
Insurance contract or identification number9260109
Number of Individuals Covered233
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,712
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $47,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,712
Insurance broker organization code?3
Insurance broker nameBENEFITSTORE, INC.
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0006865070
Policy instance 4
Insurance contract or identification number0006865070
Number of Individuals Covered241
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,381
Total amount of fees paid to insurance companyUSD $2,841
Other welfare benefits providedISWL STND, WHOLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $2,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,184
Amount paid for insurance broker fees127
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameRONALD E MCCURRY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0302893
Policy instance 3
Insurance contract or identification numberR0302893
Number of Individuals Covered1084
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,535
Total amount of fees paid to insurance companyUSD $543
Other welfare benefits providedGCIEE, GRPACCVO, GRPHSPVO
Welfare Benefit Premiums Paid to CarrierUSD $32,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,499
Amount paid for insurance broker fees540
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameALASKA EMPLOYEE BENEFIT SPECIALISTS
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16011032000
Policy instance 2
Insurance contract or identification number16011032000
Number of Individuals Covered1705
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $92,066
Total amount of fees paid to insurance companyUSD $26,615
Welfare Benefit Premiums Paid to CarrierUSD $920,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,066
Amount paid for insurance broker fees26615
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165999
Policy instance 9
Insurance contract or identification number0165999
Number of Individuals Covered984
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $80
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $120,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees80
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameBENEFITSTORE, INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0165998
Policy instance 10
Insurance contract or identification number0165998
Number of Individuals Covered1584
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $80
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees80
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameBENEFITSTORE, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 11
Insurance contract or identification number681004G
Number of Individuals Covered2898
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,302
Total amount of fees paid to insurance companyUSD $790
Other welfare benefits providedAD&D-BAS
Welfare Benefit Premiums Paid to CarrierUSD $17,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,302
Amount paid for insurance broker fees790
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 12
Insurance contract or identification number681004G
Number of Individuals Covered1746
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,811
Total amount of fees paid to insurance companyUSD $2,310
Other welfare benefits providedAD&D-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $50,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,811
Amount paid for insurance broker fees2310
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 14
Insurance contract or identification number681004G
Number of Individuals Covered739
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,996
Total amount of fees paid to insurance companyUSD $3,028
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-SDEP
Welfare Benefit Premiums Paid to CarrierUSD $66,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,996
Amount paid for insurance broker fees3028
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 15
Insurance contract or identification number681004G
Number of Individuals Covered1124
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $21,914
Total amount of fees paid to insurance companyUSD $13,284
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-VOL
Welfare Benefit Premiums Paid to CarrierUSD $291,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,914
Amount paid for insurance broker fees13284
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 16
Insurance contract or identification number681004G
Number of Individuals Covered2889
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $39,577
Total amount of fees paid to insurance companyUSD $23,990
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLTD-ABIL
Welfare Benefit Premiums Paid to CarrierUSD $526,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,577
Amount paid for insurance broker fees23990
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 17
Insurance contract or identification number681004G
Number of Individuals Covered2873
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $35,983
Total amount of fees paid to insurance companyUSD $21,811
Other welfare benefits providedWD-NST
Welfare Benefit Premiums Paid to CarrierUSD $478,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,983
Amount paid for insurance broker fees21811
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number499691
Policy instance 1
Insurance contract or identification number499691
Number of Individuals Covered69
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,747
Total amount of fees paid to insurance companyUSD $2,119
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $447,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,747
Amount paid for insurance broker fees2119
Additional information about fees paid to insurance brokerSETTLEMENT
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number681004G
Policy instance 13
Insurance contract or identification number681004G
Number of Individuals Covered2901
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $16,145
Total amount of fees paid to insurance companyUSD $9,786
Life Insurance Welfare BenefitYes
Other welfare benefits providedLIFE-BTRM
Welfare Benefit Premiums Paid to CarrierUSD $214,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,145
Amount paid for insurance broker fees9786
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameMARSH AND MCLENNAN AGENCY

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