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HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 401k Plan overview

Plan NameHOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN
Plan identification number 501

HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

HOLTHOUSE CARLIN & VAN TRIGT LLP has sponsored the creation of one or more 401k plans.

Company Name:HOLTHOUSE CARLIN & VAN TRIGT LLP
Employer identification number (EIN):954345526
NAIC Classification:541211
NAIC Description:Offices of Certified Public Accountants

Additional information about HOLTHOUSE CARLIN & VAN TRIGT LLP

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2017-12-15
Company Identification Number: 138843099
Legal Registered Office Address: 11444 W OLYMPIC BLVD 11TH FL

LOS ANGELES
United States of America (USA)
90064

More information about HOLTHOUSE CARLIN & VAN TRIGT LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01JAMES HEINZ2023-08-14 JOHN R. LILLY2023-08-15
5012020-07-01JAMES HEINZ2022-03-30 JOHN R. LILLY2022-04-05
5012019-07-01JAMES HEINZ2021-04-13 HOLTHOUSE CARLIN & VAN TRIGT LLP2021-04-13
5012018-07-01JAMES HEINZ2020-04-14
5012017-07-01
5012016-07-01
5012015-07-01CINDY COOPER
5012014-07-01
5012013-07-01
5012012-07-01JAMES HEINZ
5012011-07-01CINDY COOPER
5012010-07-01CINDY COOPER
5012009-07-01CINDY COOPER
5012009-07-01CINDY COOPER

Plan Statistics for HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN

401k plan membership statisitcs for HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN

Measure Date Value
2021: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01622
Total number of active participants reported on line 7a of the Form 55002021-07-01657
Number of retired or separated participants receiving benefits2021-07-012
Total of all active and inactive participants2021-07-01659
Total participants2021-07-01659
2020: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01614
Total number of active participants reported on line 7a of the Form 55002020-07-01622
Number of retired or separated participants receiving benefits2020-07-012
Total of all active and inactive participants2020-07-01624
Total participants2020-07-01624
2019: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01588
Total number of active participants reported on line 7a of the Form 55002019-07-01616
Number of retired or separated participants receiving benefits2019-07-0110
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01626
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-07-010
Total participants2019-07-01626
Number of participants with account balances2019-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-07-010
2018: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01528
Total number of active participants reported on line 7a of the Form 55002018-07-01588
Number of retired or separated participants receiving benefits2018-07-016
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01594
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-01594
Number of participants with account balances2018-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-010
2017: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01502
Total number of active participants reported on line 7a of the Form 55002017-07-01528
Number of retired or separated participants receiving benefits2017-07-017
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01535
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-01535
Number of participants with account balances2017-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-010
2016: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01437
Total number of active participants reported on line 7a of the Form 55002016-07-01493
Number of retired or separated participants receiving benefits2016-07-012
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01495
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-01495
Number of participants with account balances2016-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010
2015: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01384
Total number of active participants reported on line 7a of the Form 55002015-07-01435
Number of retired or separated participants receiving benefits2015-07-013
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01438
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-01438
Number of participants with account balances2015-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01356
Total number of active participants reported on line 7a of the Form 55002014-07-01390
Number of retired or separated participants receiving benefits2014-07-012
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01392
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-01392
Number of participants with account balances2014-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01319
Total number of active participants reported on line 7a of the Form 55002013-07-01359
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-01359
2012: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01277
Total number of active participants reported on line 7a of the Form 55002012-07-01309
Number of retired or separated participants receiving benefits2012-07-011
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01310
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01310
2011: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01258
Total number of active participants reported on line 7a of the Form 55002011-07-01272
Number of retired or separated participants receiving benefits2011-07-016
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01278
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-01278
Number of participants with account balances2011-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010
2010: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01249
Total number of active participants reported on line 7a of the Form 55002010-07-01251
Number of retired or separated participants receiving benefits2010-07-017
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-01258
Number of participants with account balances2010-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010
2009: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01251
Total number of active participants reported on line 7a of the Form 55002009-07-01239
Number of retired or separated participants receiving benefits2009-07-0110
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-01249
Number of participants with account balances2009-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-010

Form 5500 Responses for HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN

2021: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: HOLTHOUSE CARLIN & VAN TRIGT LLP WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedYes
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number803742G
Policy instance 5
Insurance contract or identification number803742G
Number of Individuals Covered657
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $58,766
Total amount of fees paid to insurance companyUSD $3,714
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND STD
Welfare Benefit Premiums Paid to CarrierUSD $360,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,766
Amount paid for insurance broker fees3714
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802428
Policy instance 4
Insurance contract or identification number802428
Number of Individuals Covered123
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $6,769
Welfare Benefit Premiums Paid to CarrierUSD $31,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,769
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 3
Insurance contract or identification number0803905
Number of Individuals Covered928
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $167,844
Total amount of fees paid to insurance companyUSD $23,457
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,894,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $167,844
Amount paid for insurance broker fees23457
Additional information about fees paid to insurance broker2021 SIGNATURE VISION, MEDICAL, DENTAL RETENTION INCENTIVE RISK
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 2
Insurance contract or identification number0803905HNO
Number of Individuals Covered154
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $45,163
Welfare Benefit Premiums Paid to CarrierUSD $1,140,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,163
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered267
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $58,877
Total amount of fees paid to insurance companyUSD $758
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,191,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,877
Amount paid for insurance broker fees758
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered257
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $69,563
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,381,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,563
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 2
Insurance contract or identification number0803905HNO
Number of Individuals Covered160
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $41,208
Welfare Benefit Premiums Paid to CarrierUSD $1,038,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,208
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802428
Policy instance 4
Insurance contract or identification number802428
Number of Individuals Covered94
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,496
Welfare Benefit Premiums Paid to CarrierUSD $19,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,496
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 3
Insurance contract or identification number0803905
Number of Individuals Covered856
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $158,958
Total amount of fees paid to insurance companyUSD $12,280
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,522,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $158,958
Amount paid for insurance broker fees12280
Additional information about fees paid to insurance broker2020 SIGNATURE MEDICAL RETENTION INCENTIVE RISK
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number803742G
Policy instance 5
Insurance contract or identification number803742G
Number of Individuals Covered622
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $39,915
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND STD
Welfare Benefit Premiums Paid to CarrierUSD $266,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,915
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 2
Insurance contract or identification number0803905HNO
Number of Individuals Covered153
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $39,214
Welfare Benefit Premiums Paid to CarrierUSD $980,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,214
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 3
Insurance contract or identification number0803905
Number of Individuals Covered854
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $150,988
Total amount of fees paid to insurance companyUSD $5,940
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,163,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150,988
Amount paid for insurance broker fees5940
Additional information about fees paid to insurance broker2019 PREMIER PRODUCER PROGRAM - MEDICAL RETENTION RISK
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802428
Policy instance 4
Insurance contract or identification number802428
Number of Individuals Covered53
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $1,951
Welfare Benefit Premiums Paid to CarrierUSD $13,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,951
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number803742G
Policy instance 5
Insurance contract or identification number803742G
Number of Individuals Covered616
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $40,176
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D AND STD
Welfare Benefit Premiums Paid to CarrierUSD $267,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,176
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered288
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $64,229
Total amount of fees paid to insurance companyUSD $1,725
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,397,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,229
Amount paid for insurance broker fees1725
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802428
Policy instance 4
Insurance contract or identification number802428
Number of Individuals Covered33
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $491
Welfare Benefit Premiums Paid to CarrierUSD $3,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $491
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 3
Insurance contract or identification number0803905
Number of Individuals Covered825
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $181,539
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & STD
Welfare Benefit Premiums Paid to CarrierUSD $3,310,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $181,539
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 2
Insurance contract or identification number0803905HNO
Number of Individuals Covered159
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $40,692
Welfare Benefit Premiums Paid to CarrierUSD $961,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,692
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered269
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $56,778
Total amount of fees paid to insurance companyUSD $1,631
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,048,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,778
Amount paid for insurance broker fees1631
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 3
Insurance contract or identification number0803905
Number of Individuals Covered767
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $157,862
Total amount of fees paid to insurance companyUSD $2,184
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & STD
Welfare Benefit Premiums Paid to CarrierUSD $3,203,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 2
Insurance contract or identification number0803905HNO
Number of Individuals Covered125
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $28,251
Welfare Benefit Premiums Paid to CarrierUSD $785,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered234
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $48,945
Total amount of fees paid to insurance companyUSD $2,252
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,067,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 1
Insurance contract or identification number226239
Number of Individuals Covered163
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $46,385
Total amount of fees paid to insurance companyUSD $38
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $683,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,110
Insurance broker organization code?3
Amount paid for insurance broker fees38
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameBURNHAM BENEFITS INSURANCE SERVICES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00501131
Policy instance 2
Insurance contract or identification number00501131
Number of Individuals Covered418
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $26,921
Total amount of fees paid to insurance companyUSD $3,280
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $336,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,328
Insurance broker organization code?3
Amount paid for insurance broker fees3280
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker nameBURNHAM BENEFITS INSURANCE SERVICES
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number0803905HNO
Policy instance 3
Insurance contract or identification number0803905HNO
Number of Individuals Covered104
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $22,688
Welfare Benefit Premiums Paid to CarrierUSD $596,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,866
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0803905
Policy instance 4
Insurance contract or identification number0803905
Number of Individuals Covered715
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $110,513
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,407,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,794
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00501131
Policy instance 7
Insurance contract or identification number00501131
Number of Individuals Covered377
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $22,688
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $283,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,688
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number165938
Policy instance 6
Insurance contract or identification number165938
Number of Individuals Covered390
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $1,238
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,238
Insurance broker organization code?3
Insurance broker nameBERNS/ROSENTHAL
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 5
Insurance contract or identification number000400001000
Number of Individuals Covered129
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,575
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $30,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,575
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010055952
Policy instance 4
Insurance contract or identification number000010055952
Number of Individuals Covered390
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $3,689
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,689
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 3
Insurance contract or identification number226239
Number of Individuals Covered136
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $31,864
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $434,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,864
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010104500000
Policy instance 2
Insurance contract or identification number000010104500000
Number of Individuals Covered390
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $5,872
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,872
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number151770
Policy instance 1
Insurance contract or identification number151770
Number of Individuals Covered475
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $102,077
Total amount of fees paid to insurance companyUSD $324
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,548,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $102,077
Amount paid for insurance broker fees324
Additional information about fees paid to insurance brokerEDUCATION & TRAINING
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010104500000
Policy instance 3
Insurance contract or identification number000010104500000
Number of Individuals Covered359
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $5,329
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,329
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number165938
Policy instance 7
Insurance contract or identification number165938
Number of Individuals Covered359
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,115
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,115
Insurance broker organization code?3
Insurance broker nameBERNS/ROSENTHAL
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 6
Insurance contract or identification number000400001000
Number of Individuals Covered124
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,972
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $26,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,972
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010055952
Policy instance 5
Insurance contract or identification number000010055952
Number of Individuals Covered359
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,331
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,331
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 4
Insurance contract or identification number226239
Number of Individuals Covered106
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $25,451
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $408,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,451
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered567
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $34,417
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $343,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,417
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number151770
Policy instance 2
Insurance contract or identification number151770
Number of Individuals Covered462
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $82,006
Total amount of fees paid to insurance companyUSD $4,764
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,029,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,006
Insurance broker organization code?3
Amount paid for insurance broker fees4764
Additional information about fees paid to insurance brokerEDUCATION & TRAINING
Insurance broker nameJAMES C. JENKINS
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number151770
Policy instance 2
Insurance contract or identification number151770
Number of Individuals Covered421
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $68,101
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,681,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,101
Insurance broker organization code?3
Insurance broker nameBERNS/ROSENTHAL
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number165938
Policy instance 7
Insurance contract or identification number165938
Number of Individuals Covered308
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $970
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $970
Insurance broker organization code?3
Insurance broker nameBERNS/ROSENTHAL
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 6
Insurance contract or identification number000400001000
Number of Individuals Covered97
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,946
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,946
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010055952
Policy instance 5
Insurance contract or identification number000010055952
Number of Individuals Covered308
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,843
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,843
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 4
Insurance contract or identification number226239
Number of Individuals Covered90
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $23,086
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $338,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,086
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010104500000
Policy instance 3
Insurance contract or identification number000010104500000
Number of Individuals Covered308
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,542
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,542
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered481
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $29,937
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $299,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,937
Insurance broker organization code?3
Insurance broker nameLEAVITT INSURANCE SERVICES OF LA
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number151770
Policy instance 2
Insurance contract or identification number151770
Number of Individuals Covered348
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $72,817
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,667,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010104500000
Policy instance 3
Insurance contract or identification number000010104500000
Number of Individuals Covered272
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $4,401
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 4
Insurance contract or identification number226239
Number of Individuals Covered83
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $21,213
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $258,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010055952
Policy instance 5
Insurance contract or identification number000010055952
Number of Individuals Covered272
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,696
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number165938
Policy instance 7
Insurance contract or identification number165938
Number of Individuals Covered269
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $877
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered465
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $27,019
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $270,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 6
Insurance contract or identification number000400001000
Number of Individuals Covered84
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,492
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )
Policy contract number165938
Policy instance 7
Insurance contract or identification number165938
Number of Individuals Covered0
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $909
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010055952
Policy instance 5
Insurance contract or identification number000010055952
Number of Individuals Covered253
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,040
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 6
Insurance contract or identification number000400001000
Number of Individuals Covered73
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,097
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number226239
Policy instance 4
Insurance contract or identification number226239
Number of Individuals Covered38
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $10,261
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010104500000
Policy instance 3
Insurance contract or identification number000010104500000
Number of Individuals Covered253
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,277
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number151770
Policy instance 2
Insurance contract or identification number151770
Number of Individuals Covered348
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $55,452
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,508,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number909
Policy instance 1
Insurance contract or identification number909
Number of Individuals Covered256
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $25,114
Total amount of fees paid to insurance companyUSD $32,823
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $250,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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