ADCO MANUFACTURING has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN
401k plan membership statisitcs for ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 161 |
| Total of all active and inactive participants | 2022-01-01 | 161 |
| Total participants | 2022-01-01 | 161 |
| 2021: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 155 |
| Total of all active and inactive participants | 2021-01-01 | 155 |
| Total participants | 2021-01-01 | 155 |
| 2020: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 155 |
| Total of all active and inactive participants | 2020-01-01 | 155 |
| Total participants | 2020-01-01 | 155 |
| 2019: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 159 |
| Total of all active and inactive participants | 2019-01-01 | 159 |
| Total participants | 2019-01-01 | 159 |
| 2018: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 149 |
| Total of all active and inactive participants | 2018-01-01 | 149 |
| Total participants | 2018-01-01 | 149 |
| 2017: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 137 |
| Total of all active and inactive participants | 2017-01-01 | 137 |
| Total participants | 2017-01-01 | 137 |
| 2016: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 139 |
| Total of all active and inactive participants | 2016-01-01 | 139 |
| Total participants | 2016-01-01 | 139 |
| 2015: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 143 |
| Total of all active and inactive participants | 2015-01-01 | 143 |
| Total participants | 2015-01-01 | 0 |
| 2014: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 147 |
| Total of all active and inactive participants | 2014-01-01 | 147 |
| Total participants | 2014-01-01 | 0 |
| 2013: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 140 |
| Total of all active and inactive participants | 2013-01-01 | 140 |
| Total participants | 2013-01-01 | 0 |
| 2012: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 140 |
| Total of all active and inactive participants | 2012-01-01 | 140 |
| Total participants | 2012-01-01 | 0 |
| 2011: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 133 |
| Total of all active and inactive participants | 2011-01-01 | 133 |
| Total participants | 2011-01-01 | 133 |
| 2010: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 115 |
| Total of all active and inactive participants | 2010-01-01 | 115 |
| Total participants | 2010-01-01 | 115 |
| 2009: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 109 |
| Total of all active and inactive participants | 2009-01-01 | 109 |
| Total participants | 2009-01-01 | 109 |
| 2022: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: ADCO MANUFACTURING CAFETERIA AND WELFARE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E4846978 |
| Policy instance | 3 |
| Insurance contract or identification number | E4846978 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $6,172 | | Total amount of fees paid to insurance company | USD $123 | | Are there contracts with allocated funds for individual policies? | 1 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,188 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 114 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 161 | | Total amount of commissions paid to insurance broker | USD $1,267 | | Total amount of fees paid to insurance company | USD $123 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $30,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $1,267 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 123 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 129 | | Total amount of commissions paid to insurance broker | USD $66,107 | | Total amount of fees paid to insurance company | USD $6,429 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,615,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $66,107 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6429 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 155 | | Total amount of commissions paid to insurance broker | USD $1,263 | | Total amount of fees paid to insurance company | USD $123 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $30,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $1,263 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 123 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 133 | | Total amount of commissions paid to insurance broker | USD $65,190 | | Total amount of fees paid to insurance company | USD $6,336 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,591,447 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $65,190 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6336 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 133 | | Total amount of commissions paid to insurance broker | USD $65,220 | | Total amount of fees paid to insurance company | USD $6,342 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,464,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $65,220 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6342 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 155 | | Total amount of commissions paid to insurance broker | USD $1,358 | | Total amount of fees paid to insurance company | USD $132 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $30,486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $1,358 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 132 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 159 | | Total amount of commissions paid to insurance broker | USD $1,293 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $29,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $1,179 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 138 | | Total amount of commissions paid to insurance broker | USD $56,944 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,285,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $51,921 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 149 | | Total amount of commissions paid to insurance broker | USD $1,104 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $26,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $982 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 132 | | Total amount of commissions paid to insurance broker | USD $42,852 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,017,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $38,112 | | Insurance broker organization code? | 3 |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 280986 |
| Policy instance | 2 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 137 | | Total amount of commissions paid to insurance broker | USD $1,403 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $24,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $949 | | Insurance broker organization code? | 3 | | Insurance broker name | LISI, INC. |
|
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 280986 |
| Policy instance | 1 |
| Insurance contract or identification number | 280986 | | Number of Individuals Covered | 125 | | Total amount of commissions paid to insurance broker | USD $45,630 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $804,913 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $30,861 | | Insurance broker organization code? | 3 | | Insurance broker name | LISI, INC. |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 2 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 143 | | Total amount of commissions paid to insurance broker | USD $3,237 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $27,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $3,237 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 1 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 135 | | Total amount of commissions paid to insurance broker | USD $54,628 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,109,896 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $54,628 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 2 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 147 | | Total amount of commissions paid to insurance broker | USD $4,364 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $27,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $4,364 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 1 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 134 | | Total amount of commissions paid to insurance broker | USD $44,985 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $938,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $44,985 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 1 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 127 | | Total amount of commissions paid to insurance broker | USD $44,062 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $919,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $44,062 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 2 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 140 | | Total amount of commissions paid to insurance broker | USD $4,510 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $26,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $4,510 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 2 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 129 | | Total amount of commissions paid to insurance broker | USD $40,130 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $868,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $40,130 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 277055 |
| Policy instance | 1 |
| Insurance contract or identification number | 277055 | | Number of Individuals Covered | 140 | | Total amount of commissions paid to insurance broker | USD $2,046 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $26,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $2,046 | | Insurance broker organization code? | 3 | | Insurance broker name | DL RICHESIN AND ASSOCIATES INS |
|
| BLUE SHIELD LIFE (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 920947 |
| Policy instance | 1 |
| Insurance contract or identification number | 920947 | | Number of Individuals Covered | 133 | | Total amount of commissions paid to insurance broker | USD $1,142 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $16,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | 920947 |
| Policy instance | 2 |
| Insurance contract or identification number | 920947 | | Number of Individuals Covered | 117 | | Total amount of commissions paid to insurance broker | USD $63,697 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $909,959 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL |
|
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
| Policy contract number | 920947 |
| Policy instance | 1 |
| Insurance contract or identification number | 920947 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $43,885 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $626,941 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP MEDICAL | | Commission paid to Insurance Broker | USD $28,337 | | Insurance broker organization code? | 3 | | Insurance broker name | LISI, INC |
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| BLUE SHIELD LIFE (National Association of Insurance Commissioners NAIC id number: 61557 ) |
| Policy contract number | 920947 |
| Policy instance | 2 |
| Insurance contract or identification number | 920947 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $969 | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | Yes | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | GROUP LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $13,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Other information about contract | GROUP LIFE | | Commission paid to Insurance Broker | USD $692 | | Insurance broker organization code? | 3 | | Insurance broker name | LISI, INC |
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