LIFECENTER NORTHWEST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2022: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-01-01 | 174 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 193 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 195 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-01-01 | 161 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 174 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 174 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 151 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 161 |
Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
Total of all active and inactive participants | 2020-01-01 | 161 |
Number of employers contributing to the scheme | 2020-01-01 | 0 |
2019: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 141 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 151 |
Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
Total of all active and inactive participants | 2019-01-01 | 151 |
Number of employers contributing to the scheme | 2019-01-01 | 0 |
2018: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 131 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 221 |
Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
Total of all active and inactive participants | 2018-01-01 | 221 |
Number of employers contributing to the scheme | 2018-01-01 | 0 |
2017: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 131 |
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 | 131 |
2016: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 127 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 125 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
Total of all active and inactive participants | 2016-10-01 | 125 |
2015: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 127 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
Total of all active and inactive participants | 2015-10-01 | 127 |
2022: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2022 form 5500 responses |
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2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2021 form 5500 responses |
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2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: LIFECENTER NORTHWEST HEALTH AND WELFARE 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 – Insurance | 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 – General assets of the sponsor | Yes |
2018: LIFECENTER NORTHWEST HEALTH AND WELFARE 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 | Yes |
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: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: LIFECENTER NORTHWEST HEALTH AND WELFARE PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | First time form 5500 has been submitted | Yes |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | LCNW00-01 |
Policy instance | 5 |
Insurance contract or identification number | LCNW00-01 | Number of Individuals Covered | 199 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $4,717 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) |
Policy contract number | 10051555 |
Policy instance | 4 |
Insurance contract or identification number | 10051555 | Number of Individuals Covered | 321 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $83,561 | Total amount of fees paid to insurance company | USD $10,013 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,675,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $83,561 | Amount paid for insurance broker fees | 10013 | Additional information about fees paid to insurance broker | BONUS, NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948295 |
Policy instance | 3 |
Insurance contract or identification number | 5948295 | Number of Individuals Covered | 305 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $17,070 | Total amount of fees paid to insurance company | USD $1,156 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $87,096 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,070 | Amount paid for insurance broker fees | 1156 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12134652 |
Policy instance | 2 |
Insurance contract or identification number | 12134652 | Number of Individuals Covered | 187 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,307 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,307 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 10363 |
Policy instance | 1 |
Insurance contract or identification number | 10363 | Number of Individuals Covered | 374 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $10,948 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,948 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 10363 |
Policy instance | 1 |
Insurance contract or identification number | 10363 | Number of Individuals Covered | 305 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $6,931 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,931 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12134652 |
Policy instance | 2 |
Insurance contract or identification number | 12134652 | Number of Individuals Covered | 174 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,069 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,843 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,069 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05948295 |
Policy instance | 3 |
Insurance contract or identification number | KM05948295 | Number of Individuals Covered | 240 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $14,318 | Total amount of fees paid to insurance company | USD $952 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $66,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,318 | Amount paid for insurance broker fees | 952 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 8182700 |
Policy instance | 4 |
Insurance contract or identification number | 8182700 | Number of Individuals Covered | 267 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $61,634 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,393,049 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $61,634 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 ) |
Policy contract number | 4016351 |
Policy instance | 5 |
Insurance contract or identification number | 4016351 | Number of Individuals Covered | 3 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,975 | Total amount of fees paid to insurance company | USD $175 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,975 | Amount paid for insurance broker fees | 175 | Additional information about fees paid to insurance broker | PREFERRED PRODUCER PROGRAM | Insurance broker organization code? | 3 |
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CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | LCNW00-01 |
Policy instance | 6 |
Insurance contract or identification number | LCNW00-01 | Number of Individuals Covered | 149 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $3,397 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 ) |
Policy contract number | 4016351 |
Policy instance | 5 |
Insurance contract or identification number | 4016351 | Number of Individuals Covered | 3 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,271 | Total amount of fees paid to insurance company | USD $215 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,430 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,271 | Amount paid for insurance broker fees | 215 | Additional information about fees paid to insurance broker | PREFERRED PRODUCER PROGRAM | Insurance broker organization code? | 3 |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 8182700 |
Policy instance | 4 |
Insurance contract or identification number | 8182700 | Number of Individuals Covered | 229 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $67,391 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,405,936 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $67,391 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5948295 |
Policy instance | 3 |
Insurance contract or identification number | 5948295 | Number of Individuals Covered | 235 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $13,139 | Total amount of fees paid to insurance company | USD $981 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $71,717 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,139 | Amount paid for insurance broker fees | 981 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12134652 |
Policy instance | 2 |
Insurance contract or identification number | 12134652 | Number of Individuals Covered | 164 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,088 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,487 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,088 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 10363 |
Policy instance | 1 |
Insurance contract or identification number | 10363 | Number of Individuals Covered | 260 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $6,935 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,935 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 10363 |
Policy instance | 1 |
Insurance contract or identification number | 10363 | Number of Individuals Covered | 248 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $6,755 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,755 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12134652 |
Policy instance | 2 |
Insurance contract or identification number | 12134652 | Number of Individuals Covered | 154 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,040 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,156 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,040 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05948295 |
Policy instance | 3 |
Insurance contract or identification number | KM05948295 | Number of Individuals Covered | 220 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $12,286 | Total amount of fees paid to insurance company | USD $1,919 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $61,446 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,286 | Amount paid for insurance broker fees | 1919 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 ) |
Policy contract number | 8182700 |
Policy instance | 4 |
Insurance contract or identification number | 8182700 | Number of Individuals Covered | 221 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $59,415 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,197,068 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $59,415 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PREMERA BLUE CROSS BLUE SHIELD OF ALASKA, INC. (National Association of Insurance Commissioners NAIC id number: 11677 ) |
Policy contract number | 4016351 |
Policy instance | 5 |
Insurance contract or identification number | 4016351 | Number of Individuals Covered | 4 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,970 | Total amount of fees paid to insurance company | USD $126 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,970 | Amount paid for insurance broker fees | 126 | Additional information about fees paid to insurance broker | PREFERRED PRODUCER PROGRAM | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM606806 |
Policy instance | 3 |
Insurance contract or identification number | SGM606806 | Number of Individuals Covered | 127 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $12,667 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $71,297 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,667 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 ) |
Policy contract number | 12134652 |
Policy instance | 2 |
Insurance contract or identification number | 12134652 | Number of Individuals Covered | 126 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $913 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,806 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $913 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
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DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 ) |
Policy contract number | 10363 |
Policy instance | 1 |
Insurance contract or identification number | 10363 | Number of Individuals Covered | 201 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $5,996 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,996 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
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