NEW CENTURY AUTO GROUP has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN
Measure | Date | Value |
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2022: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-02-01 | 763 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 762 |
Number of retired or separated participants receiving benefits | 2022-02-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
Total of all active and inactive participants | 2022-02-01 | 767 |
2021: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-02-01 | 857 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 762 |
Number of retired or separated participants receiving benefits | 2021-02-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
Total of all active and inactive participants | 2021-02-01 | 763 |
2020: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-02-01 | 992 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 857 |
Total of all active and inactive participants | 2020-02-01 | 857 |
2019: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-12-01 | 974 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 992 |
Total of all active and inactive participants | 2019-12-01 | 992 |
2018: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-12-01 | 929 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 974 |
Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
Total of all active and inactive participants | 2018-12-01 | 974 |
2017: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-12-01 | 960 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 918 |
Number of retired or separated participants receiving benefits | 2017-12-01 | 11 |
Total of all active and inactive participants | 2017-12-01 | 929 |
2016: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-12-01 | 745 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 1,010 |
Number of retired or separated participants receiving benefits | 2016-12-01 | 4 |
Total of all active and inactive participants | 2016-12-01 | 1,014 |
2015: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-12-01 | 804 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 726 |
Number of retired or separated participants receiving benefits | 2015-12-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
Total of all active and inactive participants | 2015-12-01 | 733 |
Total participants | 2015-12-01 | 733 |
2014: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-12-01 | 652 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 803 |
Number of retired or separated participants receiving benefits | 2014-12-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
Total of all active and inactive participants | 2014-12-01 | 804 |
2013: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-12-01 | 377 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 650 |
Number of retired or separated participants receiving benefits | 2013-12-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
Total of all active and inactive participants | 2013-12-01 | 652 |
2012: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-12-01 | 370 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 371 |
Number of retired or separated participants receiving benefits | 2012-12-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2012-12-01 | 0 |
Total of all active and inactive participants | 2012-12-01 | 377 |
2011: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-12-01 | 295 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 364 |
Number of retired or separated participants receiving benefits | 2011-12-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2011-12-01 | 0 |
Total of all active and inactive participants | 2011-12-01 | 370 |
2009: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-12-01 | 241 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 272 |
Number of retired or separated participants receiving benefits | 2009-12-01 | 12 |
Number of other retired or separated participants entitled to future benefits | 2009-12-01 | 0 |
Total of all active and inactive participants | 2009-12-01 | 284 |
2022: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2022 form 5500 responses |
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2022-02-01 | Type of plan entity | Single employer plan |
2022-02-01 | Submission has been amended | No |
2022-02-01 | This submission is the final filing | No |
2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-02-01 | Plan is a collectively bargained plan | No |
2022-02-01 | Plan funding arrangement – Insurance | Yes |
2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-02-01 | Plan benefit arrangement – Insurance | Yes |
2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-02-01 | Type of plan entity | Single employer plan |
2021-02-01 | Submission has been amended | No |
2021-02-01 | This submission is the final filing | No |
2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-02-01 | Plan is a collectively bargained plan | No |
2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-02-01 | Plan benefit arrangement – Insurance | Yes |
2020: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-02-01 | Type of plan entity | Single employer plan |
2020-02-01 | Submission has been amended | No |
2020-02-01 | This submission is the final filing | No |
2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-02-01 | Plan is a collectively bargained plan | No |
2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-02-01 | Plan benefit arrangement – Insurance | Yes |
2019: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2019 form 5500 responses |
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2019-12-01 | Type of plan entity | Single employer plan |
2019-12-01 | Submission has been amended | No |
2019-12-01 | This submission is the final filing | No |
2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2019-12-01 | Plan is a collectively bargained plan | No |
2019-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-12-01 | Plan benefit arrangement – Insurance | Yes |
2018: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2018 form 5500 responses |
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2018-12-01 | Type of plan entity | Single employer plan |
2018-12-01 | Submission has been amended | No |
2018-12-01 | This submission is the final filing | No |
2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-12-01 | Plan is a collectively bargained plan | No |
2018-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-12-01 | Plan benefit arrangement – Insurance | Yes |
2017: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2017 form 5500 responses |
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2017-12-01 | Type of plan entity | Single employer plan |
2017-12-01 | Submission has been amended | No |
2017-12-01 | This submission is the final filing | No |
2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-12-01 | Plan is a collectively bargained plan | No |
2017-12-01 | Plan funding arrangement – Insurance | Yes |
2017-12-01 | Plan benefit arrangement – Insurance | Yes |
2016: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2016 form 5500 responses |
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2016-12-01 | Type of plan entity | Single employer plan |
2016-12-01 | Submission has been amended | No |
2016-12-01 | This submission is the final filing | No |
2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-12-01 | Plan is a collectively bargained plan | No |
2016-12-01 | Plan funding arrangement – Insurance | Yes |
2016-12-01 | Plan benefit arrangement – Insurance | Yes |
2015: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2015 form 5500 responses |
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2015-12-01 | Type of plan entity | Single employer plan |
2015-12-01 | Submission has been amended | No |
2015-12-01 | This submission is the final filing | No |
2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-12-01 | Plan is a collectively bargained plan | No |
2015-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-12-01 | Plan benefit arrangement – Insurance | Yes |
2014: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2014 form 5500 responses |
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2014-12-01 | Type of plan entity | Single employer plan |
2014-12-01 | Submission has been amended | No |
2014-12-01 | This submission is the final filing | No |
2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-12-01 | Plan is a collectively bargained plan | No |
2014-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-12-01 | Plan benefit arrangement – Insurance | Yes |
2013: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2013 form 5500 responses |
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2013-12-01 | Type of plan entity | Single employer plan |
2013-12-01 | Submission has been amended | No |
2013-12-01 | This submission is the final filing | No |
2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-12-01 | Plan is a collectively bargained plan | No |
2013-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-12-01 | Plan benefit arrangement – Insurance | Yes |
2012: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2012 form 5500 responses |
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2012-12-01 | Type of plan entity | Single employer plan |
2012-12-01 | Submission has been amended | No |
2012-12-01 | This submission is the final filing | No |
2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-12-01 | Plan is a collectively bargained plan | No |
2012-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-12-01 | Plan benefit arrangement – Insurance | Yes |
2011: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2011 form 5500 responses |
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2011-12-01 | Type of plan entity | Single employer plan |
2011-12-01 | Submission has been amended | No |
2011-12-01 | This submission is the final filing | No |
2011-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-12-01 | Plan is a collectively bargained plan | No |
2011-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-12-01 | Plan benefit arrangement – Insurance | Yes |
2009: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2009 form 5500 responses |
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2009-12-01 | Type of plan entity | Single employer plan |
2009-12-01 | Submission has been amended | No |
2009-12-01 | This submission is the final filing | No |
2009-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-12-01 | Plan is a collectively bargained plan | No |
2009-12-01 | Plan funding arrangement – Insurance | Yes |
2009-12-01 | Plan benefit arrangement – Insurance | Yes |
2008: NEW CENTURY AUTO GROUP WELFARE BENEFITS PLAN 2008 form 5500 responses |
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2008-12-01 | Type of plan entity | Single employer plan |
2008-12-01 | Submission has been amended | No |
2008-12-01 | This submission is the final filing | No |
2008-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-12-01 | Plan is a collectively bargained plan | No |
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 4 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 340 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $64,724 | 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 | Yes | 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 $2,198,976 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,724 | Insurance broker organization code? | 3 |
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BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
Policy contract number | W0070340 |
Policy instance | 3 |
Insurance contract or identification number | W0070340 | Number of Individuals Covered | 757 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $548 | 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 | 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 | 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 $5,481 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $548 | Insurance broker organization code? | 3 |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 29577-99623 |
Policy instance | 2 |
Insurance contract or identification number | 29577-99623 | Number of Individuals Covered | 310 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $57,011 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/ACCIDENT | 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 $578,880 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,664 | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0070340 |
Policy instance | 1 |
Insurance contract or identification number | W0070340 | Number of Individuals Covered | 452 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $10,368 | Total amount of fees paid to insurance company | USD $115,301 | 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $2,557,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,368 | Amount paid for insurance broker fees | 115301 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 2 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 329 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $55,879 | Total amount of fees paid to insurance company | USD $960 | 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 | Yes | 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 $1,731,401 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $55,879 | Amount paid for insurance broker fees | 960 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0070340 |
Policy instance | 3 |
Insurance contract or identification number | W0070340 | Number of Individuals Covered | 447 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $9,342 | Total amount of fees paid to insurance company | USD $101,094 | 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $2,218,830 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,342 | Amount paid for insurance broker fees | 101094 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 ) |
Policy contract number | W0070340 |
Policy instance | 4 |
Insurance contract or identification number | W0070340 | Number of Individuals Covered | 762 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $481 | 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 | 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 | 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 $4,806 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $481 | Insurance broker organization code? | 3 |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 29577-99623 |
Policy instance | 1 |
Insurance contract or identification number | 29577-99623 | Number of Individuals Covered | 218 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $62,512 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/ACCIDENT | 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 $461,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,840 | Insurance broker organization code? | 3 |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 29577 ET AL |
Policy instance | 1 |
Insurance contract or identification number | 29577 ET AL | Number of Individuals Covered | 204 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $34,853 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/ACCIDENT | 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 $345,222 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,881 | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0070340 |
Policy instance | 2 |
Insurance contract or identification number | W0070340 | Number of Individuals Covered | 354 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $169 | Total amount of fees paid to insurance company | USD $90,037 | 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 | Yes | 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 $1,864,771 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $169 | Amount paid for insurance broker fees | 90037 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | 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 | 5127491 |
Policy instance | 4 |
Insurance contract or identification number | 5127491 | Number of Individuals Covered | 857 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $29,169 | Total amount of fees paid to insurance company | USD $3,573 | 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 | Yes | Vision Insurance Welfare Benefit | Yes | 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 | 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 $267,549 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,453 | Amount paid for insurance broker fees | 3379 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | 5127491 |
Policy instance | 5 |
Insurance contract or identification number | 5127491 | Number of Individuals Covered | 337 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $4,470 | Total amount of fees paid to insurance company | USD $559 | 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 | Yes | 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 $53,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,470 | Amount paid for insurance broker fees | 559 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 3 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 360 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $61,310 | Total amount of fees paid to insurance company | USD $3,723 | 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 | Yes | 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 $1,677,783 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $60,450 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3723 | Additional information about fees paid to insurance broker | BONUS |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | 5127491 |
Policy instance | 6 |
Insurance contract or identification number | 5127491 | Number of Individuals Covered | 992 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $1,969 | Total amount of fees paid to insurance company | USD $125 | 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 | 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 $14,364 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,559 | Amount paid for insurance broker fees | 91 | Additional information about fees paid to insurance broker | NON-MARKETING COMPENSATION MARKETING FEES | Insurance broker organization code? | 3 |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 67209 |
Policy instance | 1 |
Insurance contract or identification number | 67209 | Number of Individuals Covered | 54 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $15,989 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/ACCIDENT | 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 $119 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,989 | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | VARIOUS |
Policy instance | 2 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 168 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $3,873 | Total amount of fees paid to insurance company | USD $1,175 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/CRITICAL ILLNESS | 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 $23,377 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,873 | Amount paid for insurance broker fees | 1175 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 3336572 |
Policy instance | 3 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 308 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $9,056 | 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 | Yes | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,032 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3336572 |
Policy instance | 4 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 729 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $9,390 | Total amount of fees paid to insurance company | USD $6,393 | 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $165,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,342 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 6393 | Additional information about fees paid to insurance broker | SERVICE/GEN. AGENT FEES |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 5 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 458 | Insurance policy start date | 2019-12-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $13,261 | 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 | Yes | 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 $374,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,952 | Insurance broker organization code? | 3 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 3 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 438 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $81,568 | 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 | Yes | 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 $2,392,498 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $77,059 | Insurance broker organization code? | 3 |
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CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 3336572 |
Policy instance | 4 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 314 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $80,151 | 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 | Yes | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $70,847 | Insurance broker organization code? | 3 |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3336572 |
Policy instance | 5 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 725 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $55,671 | Total amount of fees paid to insurance company | USD $832 | 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $915,633 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $47,353 | Amount paid for insurance broker fees | 832 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | VARIOUS |
Policy instance | 6 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 185 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $37,014 | Total amount of fees paid to insurance company | USD $2,177 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/CRITICAL ILLNESS | 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 $177,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,014 | Amount paid for insurance broker fees | 2177 | Additional information about fees paid to insurance broker | ADDITIONAL 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 | 5127491 |
Policy instance | 1 |
Insurance contract or identification number | 5127491 | Number of Individuals Covered | 974 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | Total amount of commissions paid to insurance broker | USD $15,406 | Total amount of fees paid to insurance company | USD $739 | 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 | 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 $102,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,218 | Amount paid for insurance broker fees | 724 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 67209 |
Policy instance | 2 |
Insurance contract or identification number | 67209 | Number of Individuals Covered | 25 | Insurance policy start date | 2018-12-01 | Insurance policy end date | 2019-11-30 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | CANCER/ACCIDENT | 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 $46,643 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 231194 |
Policy instance | 19 |
Insurance contract or identification number | 231194 | Number of Individuals Covered | 412 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $99,061 | Total amount of fees paid to insurance company | USD $1,021 | 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 | Yes | 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 $2,469,242 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | K5N34 |
Policy instance | 3 |
Insurance contract or identification number | K5N34 | Number of Individuals Covered | 4 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,935 | 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 | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT, CANCER CARE & SPECIFIED HEALTH EVENT | 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 $4,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JQE56 |
Policy instance | 2 |
Insurance contract or identification number | JQE56 | Number of Individuals Covered | 9 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,563 | Total amount of fees paid to insurance company | USD $53 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN, HOSPITAL PLAN & SPECIFIED HEALTH EVENT PLAN | 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 $5,401 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | K5N40 |
Policy instance | 1 |
Insurance contract or identification number | K5N40 | Number of Individuals Covered | 5 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,244 | Total amount of fees paid to insurance company | USD $229 | 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 | VOLUNTARY ACCIDENT & HOSPITAL INDEMNITY | 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 $3,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3336572 |
Policy instance | 17 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 705 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $62,025 | 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 | Yes | Dental Insurance Welfare Benefit | Yes | 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 $894,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPV63 |
Policy instance | 13 |
Insurance contract or identification number | JPV63 | Number of Individuals Covered | 7 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,230 | 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 | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN & HOSPITAL PLAN | 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 $6,556 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | K1Z87 |
Policy instance | 11 |
Insurance contract or identification number | K1Z87 | Number of Individuals Covered | 13 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $2,662 | Total amount of fees paid to insurance company | USD $108 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT, CANCER CARE & HOSPITAL INDEMNITY | 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 $7,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | K1S34 |
Policy instance | 10 |
Insurance contract or identification number | K1S34 | Number of Individuals Covered | 24 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $7,445 | Total amount of fees paid to insurance company | USD $502 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT, CANCET CARE, SPECIFIED HEALTH EVENT & HOSPITAL INDEMNITY | 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 $18,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPT45 |
Policy instance | 4 |
Insurance contract or identification number | JPT45 | Number of Individuals Covered | 3 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $195 | Total amount of fees paid to insurance company | USD $15 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT, CANCER CARE & SPECIFIED HEALTH EVENT | 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 $1,690 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | Y9694 |
Policy instance | 5 |
Insurance contract or identification number | Y9694 | Number of Individuals Covered | 80 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $14,523 | Total amount of fees paid to insurance company | USD $1,019 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN, HOSPITAL PLAN & SPECIFIED HEALTH EVENT PLAN | 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 $72,763 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JWM61 |
Policy instance | 6 |
Insurance contract or identification number | JWM61 | Number of Individuals Covered | 7 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,400 | Total amount of fees paid to insurance company | USD $47 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN & HOSPITAL PLAN | 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 $4,419 | 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 | TS05127491 |
Policy instance | 20 |
Insurance contract or identification number | TS05127491 | Number of Individuals Covered | 1105 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $14,136 | Total amount of fees paid to insurance company | USD $1,302 | 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 | 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 $91,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 3336572 |
Policy instance | 18 |
Insurance contract or identification number | 3336572 | Number of Individuals Covered | 342 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $95,214 | 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 | Yes | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JQE52 |
Policy instance | 12 |
Insurance contract or identification number | JQE52 | Number of Individuals Covered | 11 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $3,141 | Total amount of fees paid to insurance company | USD $217 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN & HOSPITAL PLAN | 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 $11,394 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPX15 |
Policy instance | 8 |
Insurance contract or identification number | JPX15 | Number of Individuals Covered | 5 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $4,169 | Total amount of fees paid to insurance company | USD $432 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN, HOSPITAL PLAN & SPECIFIED HEALTH EVENT PLAN | 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 $16,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 ) |
Policy contract number | 67209 |
Policy instance | 16 |
Insurance contract or identification number | 67209 | Number of Individuals Covered | 26 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,610 | 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 | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER & ACCIDENT ONLY | 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 $52,060 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JQB93 |
Policy instance | 15 |
Insurance contract or identification number | JQB93 | Number of Individuals Covered | 14 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,668 | Total amount of fees paid to insurance company | USD $28 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT, CANCER CARE, HOSPITAL INDEMNITY & SPECIFIED HEALTH EVENT | 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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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPU87 |
Policy instance | 14 |
Insurance contract or identification number | JPU87 | Number of Individuals Covered | 9 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,572 | 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 | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY ACCIDENT & CANCER CARE | 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 $4,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPT48 |
Policy instance | 7 |
Insurance contract or identification number | JPT48 | Number of Individuals Covered | 9 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $1,383 | Total amount of fees paid to insurance company | USD $156 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN, HOSPITAL PLAN & SPECIFIED HEALTH EVENT PLAN | 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 $7,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | JPV81 |
Policy instance | 9 |
Insurance contract or identification number | JPV81 | Number of Individuals Covered | 13 | Insurance policy start date | 2017-12-01 | Insurance policy end date | 2018-11-30 | Total amount of commissions paid to insurance broker | USD $2,549 | Total amount of fees paid to insurance company | USD $373 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY CANCER PLAN, ACCIDENT PLAN, HOSPITAL PLAN & SPECIFIED HEALTH EVENT PLAN | 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 $17,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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