CODA, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: CODA HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 139 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 177 |
| Total of all active and inactive participants | 2022-10-01 | 177 |
| 2021: CODA HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 151 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 139 |
| Total of all active and inactive participants | 2021-10-01 | 139 |
| 2020: CODA HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 151 |
| Total of all active and inactive participants | 2020-10-01 | 151 |
| 2019: CODA HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 174 |
| Total of all active and inactive participants | 2019-10-01 | 174 |
| 2018: CODA HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 167 |
| Total of all active and inactive participants | 2018-10-01 | 167 |
| 2017: CODA HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 166 |
| Total of all active and inactive participants | 2017-10-01 | 166 |
| 2016: CODA HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 193 |
| Total of all active and inactive participants | 2016-10-01 | 193 |
| 2015: CODA HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 164 |
| Total of all active and inactive participants | 2015-10-01 | 164 |
| 2014: CODA HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 150 |
| Total of all active and inactive participants | 2014-10-01 | 150 |
| 2013: CODA HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 153 |
| Total of all active and inactive participants | 2013-10-01 | 153 |
| 2012: CODA HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 147 |
| Total of all active and inactive participants | 2012-10-01 | 147 |
| 2011: CODA HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 143 |
| Total of all active and inactive participants | 2011-10-01 | 143 |
| 2009: CODA HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 133 |
| Total of all active and inactive participants | 2009-10-01 | 133 |
| 2022: CODA HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: CODA HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: CODA HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: CODA HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: CODA HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: CODA HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CODA HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CODA HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: CODA HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CODA HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CODA HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CODA HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CODA HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: CODA HEALTH PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000C743 |
| Policy instance | 3 |
| Insurance contract or identification number | G000C743 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-11-01 | | Total amount of commissions paid to insurance broker | USD $14,139 | | Total amount of fees paid to insurance company | USD $888 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS VOLUNTARY, ACCIDEN | | Welfare Benefit Premiums Paid to Carrier | USD $141,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,139 | | Amount paid for insurance broker fees | 888 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $1,193 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,193 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $26,366 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $905,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,366 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 892033G |
| Policy instance | 3 |
| Insurance contract or identification number | 892033G | | Number of Individuals Covered | 139 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $11,276 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $98,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,825 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $646 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $646 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $22,140 | | Total amount of fees paid to insurance company | USD $3,038 | | Welfare Benefit Premiums Paid to Carrier | USD $700,766 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,963 | | Amount paid for insurance broker fees | 3038 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $39,233 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,298,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,233 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $1,022 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,022 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 892033G |
| Policy instance | 3 |
| Insurance contract or identification number | 892033G | | Number of Individuals Covered | 151 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $13,885 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | LIFE AND ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $122,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,885 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 688612 |
| Policy instance | 5 |
| Insurance contract or identification number | 688612 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-11-01 | | Total amount of commissions paid to insurance broker | USD $1,399 | | Total amount of fees paid to insurance company | USD $77 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,276 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,399 | | Amount paid for insurance broker fees | 77 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 91847 |
| Policy instance | 4 |
| Insurance contract or identification number | 91847 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-11-01 | | Total amount of commissions paid to insurance broker | USD $2,203 | | Total amount of fees paid to insurance company | USD $207 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $30,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,203 | | Amount paid for insurance broker fees | 207 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 387066 |
| Policy instance | 3 |
| Insurance contract or identification number | 387066 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-11-01 | | Total amount of commissions paid to insurance broker | USD $8,646 | | Total amount of fees paid to insurance company | USD $1,054 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,220 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,646 | | Amount paid for insurance broker fees | 1054 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $1,061 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,061 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-30 | | Total amount of commissions paid to insurance broker | USD $44,208 | | Total amount of fees paid to insurance company | USD $768 | | Welfare Benefit Premiums Paid to Carrier | USD $1,481,380 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,208 | | Amount paid for insurance broker fees | 768 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-30 | | Total amount of commissions paid to insurance broker | USD $37,212 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,242,315 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,212 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $862 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $862 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 387066 |
| Policy instance | 3 |
| Insurance contract or identification number | 387066 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-11-01 | | Total amount of commissions paid to insurance broker | USD $7,467 | | Total amount of fees paid to insurance company | USD $690 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $125,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,467 | | Amount paid for insurance broker fees | 690 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 91847 |
| Policy instance | 4 |
| Insurance contract or identification number | 91847 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-11-01 | | Total amount of commissions paid to insurance broker | USD $1,742 | | Total amount of fees paid to insurance company | USD $138 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $29,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,742 | | Amount paid for insurance broker fees | 138 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 0011662612 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011662612 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-11-01 | | Total amount of commissions paid to insurance broker | USD $3,428 | | Total amount of fees paid to insurance company | USD $184 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,372 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 130 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 0011662612 |
| Policy instance | 5 |
| Insurance contract or identification number | 0011662612 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-11-01 | | Total amount of commissions paid to insurance broker | USD $3,163 | | Total amount of fees paid to insurance company | USD $157 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 91847 |
| Policy instance | 4 |
| Insurance contract or identification number | 91847 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-11-01 | | Total amount of commissions paid to insurance broker | USD $1,991 | | Total amount of fees paid to insurance company | USD $172 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $24,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 387066 |
| Policy instance | 3 |
| Insurance contract or identification number | 387066 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-11-01 | | Total amount of commissions paid to insurance broker | USD $7,602 | | Total amount of fees paid to insurance company | USD $759 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $109,988 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30036340 |
| Policy instance | 2 |
| Insurance contract or identification number | 30036340 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $943 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1200 |
| Policy instance | 1 |
| Insurance contract or identification number | 1200 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-30 | | Total amount of commissions paid to insurance broker | USD $32,079 | | Total amount of fees paid to insurance company | USD $903 | | Welfare Benefit Premiums Paid to Carrier | USD $1,069,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
