FREMONT-RIDEOUT HEALTH GROUP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN
Measure | Date | Value |
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2019: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 1,832 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 2,160 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 9 |
Total of all active and inactive participants | 2019-01-01 | 2,169 |
2018: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 1,898 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,770 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 16 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 46 |
Total of all active and inactive participants | 2018-01-01 | 1,832 |
2017: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-05-01 | 2,071 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 1,836 |
Number of retired or separated participants receiving benefits | 2017-05-01 | 16 |
Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 46 |
Total of all active and inactive participants | 2017-05-01 | 1,898 |
Total participants, beginning-of-year | 2017-01-01 | 286 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 286 |
Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
Total of all active and inactive participants | 2017-01-01 | 286 |
2016: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-05-01 | 1,859 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 1,994 |
Number of retired or separated participants receiving benefits | 2016-05-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 70 |
Total of all active and inactive participants | 2016-05-01 | 2,071 |
Total participants, beginning-of-year | 2016-01-01 | 244 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 244 |
Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
Total of all active and inactive participants | 2016-01-01 | 244 |
2015: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-05-01 | 1,619 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 1,789 |
Number of retired or separated participants receiving benefits | 2015-05-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 69 |
Total of all active and inactive participants | 2015-05-01 | 1,859 |
2014: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-05-01 | 1,701 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 1,553 |
Number of retired or separated participants receiving benefits | 2014-05-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2014-05-01 | 59 |
Total of all active and inactive participants | 2014-05-01 | 1,619 |
2013: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-05-01 | 1,501 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 1,644 |
Number of retired or separated participants receiving benefits | 2013-05-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2013-05-01 | 55 |
Total of all active and inactive participants | 2013-05-01 | 1,701 |
2012: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-05-01 | 1,619 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 1,489 |
Number of retired or separated participants receiving benefits | 2012-05-01 | 12 |
Number of other retired or separated participants entitled to future benefits | 2012-05-01 | 0 |
Total of all active and inactive participants | 2012-05-01 | 1,501 |
2011: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-05-01 | 1,562 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 1,606 |
Number of retired or separated participants receiving benefits | 2011-05-01 | 13 |
Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
Total of all active and inactive participants | 2011-05-01 | 1,619 |
2010: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-05-01 | 1,771 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 1,511 |
Number of retired or separated participants receiving benefits | 2010-05-01 | 51 |
Number of other retired or separated participants entitled to future benefits | 2010-05-01 | 0 |
Total of all active and inactive participants | 2010-05-01 | 1,562 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-05-01 | 0 |
2009: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-05-01 | 1,560 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 1,771 |
Total of all active and inactive participants | 2009-05-01 | 1,771 |
Total participants | 2009-05-01 | 1,771 |
Total participants, beginning-of-year | 2009-01-01 | 236 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 236 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
Total of all active and inactive participants | 2009-01-01 | 236 |
Measure | Date | Value |
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2019 : FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2019 401k financial data |
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Total transfer of assets to this plan | 2019-12-31 | $69,479 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $5,567,267 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $0 |
Total income from all sources (including contributions) | 2019-12-31 | $42,725,679 |
Total of all expenses incurred | 2019-12-31 | $44,986,544 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $42,937,011 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $42,692,549 |
Value of total assets at end of year | 2019-12-31 | $3,375,881 |
Value of total assets at beginning of year | 2019-12-31 | $0 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $2,049,533 |
Total interest from all sources | 2019-12-31 | $33,130 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
Administrative expenses professional fees incurred | 2019-12-31 | $690 |
Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
Value of fidelity bond cover | 2019-12-31 | $10,000,000 |
Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
Contributions received from participants | 2019-12-31 | $3,350,801 |
Participant contributions at end of year | 2019-12-31 | $108,806 |
Participant contributions at beginning of year | 2019-12-31 | $0 |
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-12-31 | $5,561,479 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $5,444 |
Administrative expenses (other) incurred | 2019-12-31 | $31,482 |
Liabilities. Value of operating payables at end of year | 2019-12-31 | $5,788 |
Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $0 |
Total non interest bearing cash at end of year | 2019-12-31 | $179,644 |
Total non interest bearing cash at beginning of year | 2019-12-31 | $0 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Value of net income/loss | 2019-12-31 | $-2,260,865 |
Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-2,191,386 |
Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $3,081,987 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $0 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $0 |
Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $33,130 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $69,470 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
Contributions received in cash from employer | 2019-12-31 | $39,341,748 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $37,306,062 |
Contract administrator fees | 2019-12-31 | $2,017,361 |
Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $5,561,479 |
Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $0 |
Did the plan have assets held for investment | 2019-12-31 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | Yes |
Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Disclaimer |
Accountancy firm name | 2019-12-31 | MOSS ADAMS LLP |
Accountancy firm EIN | 2019-12-31 | 910189318 |
2019: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Trust | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement - Trust | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Submission has been amended | No |
2018-01-01 | This submission is the final filing | No |
2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-01-01 | Plan is a collectively bargained plan | No |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2017 form 5500 responses |
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2017-05-01 | Type of plan entity | Single employer plan |
2017-05-01 | Submission has been amended | No |
2017-05-01 | This submission is the final filing | No |
2017-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2017-05-01 | Plan is a collectively bargained plan | No |
2017-05-01 | Plan funding arrangement – Insurance | Yes |
2017-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-05-01 | Plan benefit arrangement – Insurance | Yes |
2017-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Submission has been amended | No |
2017-01-01 | This submission is the final filing | No |
2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-01-01 | Plan is a collectively bargained plan | No |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2016 form 5500 responses |
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2016-05-01 | Type of plan entity | Single employer plan |
2016-05-01 | Submission has been amended | No |
2016-05-01 | This submission is the final filing | No |
2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-05-01 | Plan is a collectively bargained plan | No |
2016-05-01 | Plan funding arrangement – Insurance | Yes |
2016-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-05-01 | Plan benefit arrangement – Insurance | Yes |
2016-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Submission has been amended | No |
2016-01-01 | This submission is the final filing | No |
2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-01-01 | Plan is a collectively bargained plan | No |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2015 form 5500 responses |
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2015-05-01 | Type of plan entity | Single employer plan |
2015-05-01 | Submission has been amended | No |
2015-05-01 | This submission is the final filing | No |
2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-05-01 | Plan is a collectively bargained plan | No |
2015-05-01 | Plan funding arrangement – Insurance | Yes |
2015-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-05-01 | Plan benefit arrangement – Insurance | Yes |
2015-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2014 form 5500 responses |
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2014-05-01 | Type of plan entity | Single employer plan |
2014-05-01 | Submission has been amended | No |
2014-05-01 | This submission is the final filing | No |
2014-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-05-01 | Plan is a collectively bargained plan | No |
2014-05-01 | Plan funding arrangement – Insurance | Yes |
2014-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-05-01 | Plan benefit arrangement – Insurance | Yes |
2014-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2013 form 5500 responses |
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2013-05-01 | Type of plan entity | Single employer plan |
2013-05-01 | Submission has been amended | No |
2013-05-01 | This submission is the final filing | No |
2013-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-05-01 | Plan is a collectively bargained plan | No |
2013-05-01 | Plan funding arrangement – Insurance | Yes |
2013-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-05-01 | Plan benefit arrangement – Insurance | Yes |
2013-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2012 form 5500 responses |
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2012-05-01 | Type of plan entity | Single employer plan |
2012-05-01 | Submission has been amended | No |
2012-05-01 | This submission is the final filing | No |
2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-05-01 | Plan is a collectively bargained plan | No |
2012-05-01 | Plan funding arrangement – Insurance | Yes |
2012-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-05-01 | Plan benefit arrangement – Insurance | Yes |
2012-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2011 form 5500 responses |
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2011-05-01 | Type of plan entity | Single employer plan |
2011-05-01 | Submission has been amended | No |
2011-05-01 | This submission is the final filing | No |
2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-05-01 | Plan is a collectively bargained plan | No |
2011-05-01 | Plan funding arrangement – Insurance | Yes |
2011-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-05-01 | Plan benefit arrangement – Insurance | Yes |
2011-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2010 form 5500 responses |
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2010-05-01 | Type of plan entity | Single employer plan |
2010-05-01 | Submission has been amended | No |
2010-05-01 | This submission is the final filing | No |
2010-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-05-01 | Plan is a collectively bargained plan | No |
2010-05-01 | Plan funding arrangement – Insurance | Yes |
2010-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-05-01 | Plan benefit arrangement – Insurance | Yes |
2010-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: FREMONT RIDEOUT HEALTH GROUP HEALTH PLAN 2009 form 5500 responses |
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2009-05-01 | Type of plan entity | Single employer plan |
2009-05-01 | Plan funding arrangement – Insurance | Yes |
2009-05-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | Submission has been amended | No |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-01-01 | Plan is a collectively bargained plan | No |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5551482 |
Policy instance | 4 |
Insurance contract or identification number | 5551482 | Number of Individuals Covered | 24 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,228 | Total amount of fees paid to insurance company | USD $482 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $30,678 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,228 | Amount paid for insurance broker fees | 482 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 69417-7 |
Policy instance | 3 |
Insurance contract or identification number | 69417-7 | Number of Individuals Covered | 1770 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,263 | Total amount of fees paid to insurance company | USD $140,903 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | INDIVIDUAL EXCESS RISK, ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,598,935 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 130151 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $7,263 |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 6090336 |
Policy instance | 2 |
Insurance contract or identification number | 6090336 | Number of Individuals Covered | 267 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $5,721 | Total amount of fees paid to insurance company | USD $927 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | LEGAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $53,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,721 | Amount paid for insurance broker fees | 701 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 1 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1672 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $11,217 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,217 | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19363 |
Policy instance | 2 |
Insurance contract or identification number | C19363 | Number of Individuals Covered | 7 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2017-12-31 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $21 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 6090336 |
Policy instance | 3 |
Insurance contract or identification number | 6090336 | Number of Individuals Covered | 257 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $5,909 | Total amount of fees paid to insurance company | USD $95 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | LEGAL | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $57,322 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,909 | Amount paid for insurance broker fees | 95 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSTAION | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE INC. |
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RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
Policy contract number | 69417-7 |
Policy instance | 4 |
Insurance contract or identification number | 69417-7 | Number of Individuals Covered | 4500 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $11,918 | Total amount of fees paid to insurance company | USD $128,859 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | INDIVIDUAL EXCESS RISK, AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,989,078 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,918 | Amount paid for insurance broker fees | 128859 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE INC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 5 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 26 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $3,579 | Total amount of fees paid to insurance company | USD $591 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $27,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,579 | Amount paid for insurance broker fees | 591 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 1 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1738 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $8,607 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $172,144 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,607 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE INC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 1 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1855 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $12,352 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,352 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE INC |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0148430 |
Policy instance | 2 |
Insurance contract or identification number | 0148430 | Number of Individuals Covered | 1908 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $210,085 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19363 |
Policy instance | 3 |
Insurance contract or identification number | C19363 | Number of Individuals Covered | 1929 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $9,073 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $86,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,073 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 4 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 31 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $3,895 | Total amount of fees paid to insurance company | USD $642 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $35,726 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,146 | Amount paid for insurance broker fees | 31 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON DELAWARE |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 1 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1725 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $10,684 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,684 | Insurance broker organization code? | 3 | Insurance broker name | GEORGE A BRAVOS |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0148430 |
Policy instance | 2 |
Insurance contract or identification number | 0148430 | Number of Individuals Covered | 1773 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $171,640 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19363 |
Policy instance | 3 |
Insurance contract or identification number | C19363 | Number of Individuals Covered | 3933 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $11,290 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $96,017 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,290 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 4 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 29 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of commissions paid to insurance broker | USD $3,792 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $34,758 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,792 | Insurance broker organization code? | 3 | Insurance broker name | WILLIAM BRAVOS |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19363 |
Policy instance | 3 |
Insurance contract or identification number | C19363 | Number of Individuals Covered | 3759 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $-14,866 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $78,427 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $-14,866 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 0148430 |
Policy instance | 2 |
Insurance contract or identification number | 0148430 | Number of Individuals Covered | 1707 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $153,892 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 1 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1588 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 2 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1551 | Insurance policy start date | 2011-08-01 | Insurance policy end date | 2012-07-31 | Total amount of commissions paid to insurance broker | USD $11,163 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,163 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | GEORGE A BRAVOS |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | C19363 |
Policy instance | 3 |
Insurance contract or identification number | C19363 | Number of Individuals Covered | 1 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $20,040 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $76,438 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,040 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 4 | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 1 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 35 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $3,645 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $35,849 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,645 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | WILLIAM H BRAVOS |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 3 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1491 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $9,956 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 2 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 47 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $3,919 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $41,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 119363 |
Policy instance | 1 |
Insurance contract or identification number | 119363 | Number of Individuals Covered | 1419 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $5,574 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $189,038 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 12052248 |
Policy instance | 3 |
Insurance contract or identification number | 12052248 | Number of Individuals Covered | 1546 | Insurance policy start date | 2009-08-01 | Insurance policy end date | 2010-07-31 | Total amount of commissions paid to insurance broker | USD $10,698 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05551482 |
Policy instance | 2 |
Insurance contract or identification number | KM05551482 | Number of Individuals Covered | 48 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $4,295 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,239 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 119363 |
Policy instance | 1 |
Insurance contract or identification number | 119363 | Number of Individuals Covered | 1373 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $565,257 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD & D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,086,436 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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