AMADA WELD TECH INC. has sponsored the creation of one or more 401k plans.
Additional information about AMADA WELD TECH INC.
Submission information for form 5500 for 401k plan AMADA WELD TECH INC. HEALTH & WELFARE PLAN
401k plan membership statisitcs for AMADA WELD TECH INC. HEALTH & WELFARE PLAN
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0067686 |
Policy instance | 2 |
Insurance contract or identification number | W0067686 | Number of Individuals Covered | 188 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $31 | Total amount of fees paid to insurance company | USD $38,847 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,179,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $31 | Amount paid for insurance broker fees | 38847 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES, BONUS OVERRIDE | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM611542 |
Policy instance | 6 |
Insurance contract or identification number | SGM611542 | Number of Individuals Covered | 138 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $6,491 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $64,907 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $6,491 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 5 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 179 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $6 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 6 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 4 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 125 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,701 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $63,916 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,727 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 308732 |
Policy instance | 3 |
Insurance contract or identification number | 308732 | Number of Individuals Covered | 84 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,176 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $15,649 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,176 | Amount paid for insurance broker fees | 0 | 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 | 225735 |
Policy instance | 1 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 102 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $24,585 | Total amount of fees paid to insurance company | USD $4 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $768,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,585 | Amount paid for insurance broker fees | 4 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
|
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0067686 |
Policy instance | 2 |
Insurance contract or identification number | W0067686 | Number of Individuals Covered | 200 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $32 | Total amount of fees paid to insurance company | USD $36,371 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,176,694 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32 | Amount paid for insurance broker fees | 36371 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | 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 | 225735 |
Policy instance | 1 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 98 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $20,501 | Total amount of fees paid to insurance company | USD $27 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $702,395 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,461 | Amount paid for insurance broker fees | 27 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGM611542 |
Policy instance | 7 |
Insurance contract or identification number | SGM611542 | Number of Individuals Covered | 136 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $6,440 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $64,404 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $6,440 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 308732 |
Policy instance | 4 |
Insurance contract or identification number | 308732 | Number of Individuals Covered | 27 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS, HOSPITAL | Welfare Benefit Premiums Paid to Carrier | USD $16,308 | 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 | 3344194 |
Policy instance | 3 |
Insurance contract or identification number | 3344194 | Number of Individuals Covered | 136 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $12,436 | Total amount of fees paid to insurance company | USD $985 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $159,628 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,436 | Amount paid for insurance broker fees | 985 | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 5 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 130 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $9,048 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $62,943 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,653 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 6 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 136 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $35 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 35 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 1 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 102 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $21,994 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $706,668 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,913 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 2 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 160 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $11,546 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $71,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,318 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 3 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 156 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $35 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 32 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker organization code? | 5 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10248114 |
Policy instance | 5 |
Insurance contract or identification number | 10248114 | Number of Individuals Covered | 156 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $5,955 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $59,549 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,675 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0067686 |
Policy instance | 4 |
Insurance contract or identification number | W0067686 | Number of Individuals Covered | 229 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $17,027 | Total amount of fees paid to insurance company | USD $39,924 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,445,852 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,471 | Amount paid for insurance broker fees | 26946 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 3 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $669 | Total amount of fees paid to insurance company | USD $41 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $4,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $669 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 6 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 5 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD604667 |
Policy instance | 4 |
Insurance contract or identification number | SGD604667 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 281549 |
Policy instance | 3 |
Insurance contract or identification number | 281549 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 ) |
Policy contract number | W0067686 |
Policy instance | 4 |
Insurance contract or identification number | W0067686 | Number of Individuals Covered | 246 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $17,179 | Total amount of fees paid to insurance company | USD $49,691 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,348,296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,179 | Amount paid for insurance broker fees | 49691 | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEES BONUS OVERRIDE NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 |
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HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | VARIOUS |
Policy instance | 2 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 1 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 179 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $26,776 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10248114 |
Policy instance | 5 |
Insurance contract or identification number | 10248114 | Number of Individuals Covered | 174 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $8,085 | Total amount of fees paid to insurance company | USD $2,425 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $80,851 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,085 | Amount paid for insurance broker fees | 2425 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 2 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 160 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $18,194 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $73,836 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,365 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 2 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 179 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $213 | Total amount of fees paid to insurance company | USD $41 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $213 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 41 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 281549 |
Policy instance | 3 |
Insurance contract or identification number | 281549 | Number of Individuals Covered | 150 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $11,069 | Total amount of fees paid to insurance company | USD $3,129 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $132,584 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,069 | Amount paid for insurance broker fees | 3129 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 |
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HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | VARIOUS |
Policy instance | 5 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 147 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $43,137 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,436,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $43,137 | Insurance broker organization code? | 3 |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 6 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 158 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $10,022 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $61,772 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,602 | Insurance broker organization code? | 3 |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD604667 |
Policy instance | 1 |
Insurance contract or identification number | SGD604667 | Number of Individuals Covered | 154 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,609 | Total amount of fees paid to insurance company | USD $1,067 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $66,087 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,609 | Amount paid for insurance broker fees | 1067 | Additional information about fees paid to insurance broker | SALES & SERVICE | 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 | 225735 |
Policy instance | 4 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 45 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $30,193 | Welfare Benefit Premiums Paid to Carrier | USD $742,050 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,193 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 907731 |
Policy instance | 3 |
Insurance contract or identification number | 907731 | Number of Individuals Covered | 120 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $12,760 | Total amount of fees paid to insurance company | USD $3,863 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $127,816 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,760 | Amount paid for insurance broker fees | 3863 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 97EX001182 |
Policy instance | 6 |
Insurance contract or identification number | 97EX001182 | Number of Individuals Covered | 146 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $11,352 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $64,783 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,554 | Insurance broker organization code? | 3 | Insurance broker name | LEISURE WERDEN & TERRY AGENCY |
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HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
Policy contract number | VARIOUS |
Policy instance | 5 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 142 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $40,064 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,350,334 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,064 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 4 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 47 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $27,790 | Total amount of fees paid to insurance company | USD $1 | Welfare Benefit Premiums Paid to Carrier | USD $678,574 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,790 | Amount paid for insurance broker fees | 1 | Additional information about fees paid to insurance broker | ADMINISTRATIVE SUPPORT | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 2 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 179 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $213 | Total amount of fees paid to insurance company | USD $43 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $213 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 43 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker name | AXA ASSISTANCE, USA |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD604667 |
Policy instance | 1 |
Insurance contract or identification number | SGD604667 | Number of Individuals Covered | 171 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $10,196 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,196 | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VARIOUS |
Policy instance | 6 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 168 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $8,622 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $86,224 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,622 | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
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UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 ) |
Policy contract number | 907731-199 |
Policy instance | 8 |
Insurance contract or identification number | 907731-199 | Number of Individuals Covered | 31 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $714 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,800 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $648 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0803869 |
Policy instance | 5 |
Insurance contract or identification number | 0803869 | Number of Individuals Covered | 146 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $13,851 | Total amount of fees paid to insurance company | USD $4,795 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $488,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,396 | Amount paid for insurance broker fees | 4795 | Additional information about fees paid to insurance broker | 2014/2015 PPP ENGAGEMENT CREDIT | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 1 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 44 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $22,171 | Welfare Benefit Premiums Paid to Carrier | USD $540,758 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,234 | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 2 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 180 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $213 | Total amount of fees paid to insurance company | USD $65 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $213 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 65 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATIVE FEES | Insurance broker name | AXA ASSISTANCE, USA |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 59EV001250 |
Policy instance | 3 |
Insurance contract or identification number | 59EV001250 | Number of Individuals Covered | 155 | Insurance policy start date | 2016-01-01 | Insurance policy end date | 2016-12-31 | Total amount of commissions paid to insurance broker | USD $8,486 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $60,668 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,784 | Insurance broker organization code? | 3 | Insurance broker name | LEISURE WERDEN & TERRY AGENCY |
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AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95245 ) |
Policy contract number | 0803869HNO |
Policy instance | 4 |
Insurance contract or identification number | 0803869HNO | Number of Individuals Covered | 79 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $25,186 | Welfare Benefit Premiums Paid to Carrier | USD $850,202 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,317 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
Policy contract number | 907731-000 |
Policy instance | 7 |
Insurance contract or identification number | 907731-000 | Number of Individuals Covered | 116 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $11,115 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $120,944 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,113 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
|
AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95245 ) |
Policy contract number | 0803869HNO |
Policy instance | 6 |
Insurance contract or identification number | 0803869HNO | Number of Individuals Covered | 69 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $17,756 | Total amount of fees paid to insurance company | USD $5,050 | Welfare Benefit Premiums Paid to Carrier | USD $646,230 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,756 | Amount paid for insurance broker fees | 5050 | Additional information about fees paid to insurance broker | WEST JANUARY MEDICAL SUPERBONUS | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 671878 |
Policy instance | 1 |
Insurance contract or identification number | 671878 | Number of Individuals Covered | 112 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $11,788 | Total amount of fees paid to insurance company | USD $3,419 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,877 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,788 | Amount paid for insurance broker fees | 3419 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | KM05730855 |
Policy instance | 2 |
Insurance contract or identification number | KM05730855 | Number of Individuals Covered | 38 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $1,022 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,292 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,022 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0803869 |
Policy instance | 7 |
Insurance contract or identification number | 0803869 | Number of Individuals Covered | 136 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $13,434 | Total amount of fees paid to insurance company | USD $4,673 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $508,478 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,434 | Amount paid for insurance broker fees | 4673 | Additional information about fees paid to insurance broker | 2013/2014 MM P3 BONUS | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | VARIOUS |
Policy instance | 8 |
Insurance contract or identification number | VARIOUS | Number of Individuals Covered | 165 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $7,967 | Total amount of fees paid to insurance company | USD $1,429 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $79,672 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,967 | Amount paid for insurance broker fees | 1429 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | BENEFITS AMERICA INSURANCE SERVICES |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 3 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 45 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $21,560 | Welfare Benefit Premiums Paid to Carrier | USD $489,852 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,560 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 59EV001250 |
Policy instance | 5 |
Insurance contract or identification number | 59EV001250 | Number of Individuals Covered | 153 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $7,358 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $57,297 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,035 | Insurance broker organization code? | 3 | Insurance broker name | LEISURE WERDEN & TERRY AGENCY |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 4 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 180 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $213 | Total amount of fees paid to insurance company | USD $5 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $213 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 5 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATIVE FEES | Insurance broker name | AXA ASSISTANCE, USA |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 59EV001250 |
Policy instance | 7 |
Insurance contract or identification number | 59EV001250 | Number of Individuals Covered | 154 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $8,282 | Total amount of fees paid to insurance company | USD $485 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $62,522 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,087 | Amount paid for insurance broker fees | 422 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | AXA ASSISTANCE, USA |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 6 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 180 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $213 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,418 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $213 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | KM05730855 |
Policy instance | 3 |
Insurance contract or identification number | KM05730855 | Number of Individuals Covered | 34 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $1,033 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,247 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,033 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10121574 |
Policy instance | 5 |
Insurance contract or identification number | 10121574 | Number of Individuals Covered | 164 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $5,147 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $51,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,147 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 4 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 41 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $16,540 | Welfare Benefit Premiums Paid to Carrier | USD $439,414 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,540 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 165430 |
Policy instance | 2 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 105 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $36,583 | Welfare Benefit Premiums Paid to Carrier | USD $1,219,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,583 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 165430 |
Policy instance | 1 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 166 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $17,659 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $176,851 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,659 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 2 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 136 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $160 | Total amount of fees paid to insurance company | USD $49 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,064 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 49 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATIVE FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $160 | Insurance broker name | J D GILMOUR & CO. INC. |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 165430 |
Policy instance | 8 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 179 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,903 | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $59,030 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,903 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 165430 |
Policy instance | 7 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 71 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $33,745 | Welfare Benefit Premiums Paid to Carrier | USD $1,137,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,745 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | FG1D0494 |
Policy instance | 6 |
Insurance contract or identification number | FG1D0494 | Number of Individuals Covered | 113 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $11,418 | Total amount of fees paid to insurance company | USD $3,418 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $115,741 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,418 | Amount paid for insurance broker fees | 3418 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | KM05730855 |
Policy instance | 5 |
Insurance contract or identification number | KM05730855 | Number of Individuals Covered | 34 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $1,104 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,947 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,104 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 4 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 45 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $17,375 | Welfare Benefit Premiums Paid to Carrier | USD $425,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,375 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10121574 |
Policy instance | 3 |
Insurance contract or identification number | 10121574 | Number of Individuals Covered | 172 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,223 | Total amount of fees paid to insurance company | USD $924 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $52,230 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,223 | Amount paid for insurance broker fees | 924 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) |
Policy contract number | 59EV001250 |
Policy instance | 1 |
Insurance contract or identification number | 59EV001250 | Number of Individuals Covered | 167 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $17,538 | Total amount of fees paid to insurance company | USD $3,518 | Other welfare benefits provided | LONG TERM CARE | Welfare Benefit Premiums Paid to Carrier | USD $63,822 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,847 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3518 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker name | ADVANCED LTC INSURANCE SERVICES |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | FG1D0494 |
Policy instance | 1 |
Insurance contract or identification number | FG1D0494 | Number of Individuals Covered | 101 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $9,950 | Total amount of fees paid to insurance company | USD $186 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $98,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 165430 |
Policy instance | 8 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 177 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,569 | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,685 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 7 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 136 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $160 | Total amount of fees paid to insurance company | USD $49 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,064 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 5 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 40 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $14,746 | Welfare Benefit Premiums Paid to Carrier | USD $333,704 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10121574 |
Policy instance | 6 |
Insurance contract or identification number | 10121574 | Number of Individuals Covered | 174 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,617 | Total amount of fees paid to insurance company | USD $847 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05730855 |
Policy instance | 4 |
Insurance contract or identification number | KM05730855 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $660 | Total amount of fees paid to insurance company | USD $133 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $-33 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | 5730855 |
Policy instance | 3 |
Insurance contract or identification number | 5730855 | Number of Individuals Covered | 39 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,207 | Total amount of fees paid to insurance company | USD $17 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,211 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 165430 |
Policy instance | 2 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 111 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $29,166 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $989,363 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | 165430 |
Policy instance | 1 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 92 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $24,925 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $830,819 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,925 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
Policy contract number | 165430 |
Policy instance | 7 |
Insurance contract or identification number | 165430 | Number of Individuals Covered | 141 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $3,679 | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,652 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,679 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 42710 |
Policy instance | 6 |
Insurance contract or identification number | 42710 | Number of Individuals Covered | 136 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $160 | Total amount of fees paid to insurance company | USD $50 | Other welfare benefits provided | TRAVEL ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $1,064 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 50 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 5 | Commission paid to Insurance Broker | USD $160 | Insurance broker name | J D GILMOUR & CO., INC. |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 10121574 |
Policy instance | 5 |
Insurance contract or identification number | 10121574 | Number of Individuals Covered | 134 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $4,233 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,333 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,233 | Insurance broker organization code? | 3 | Insurance broker name | J. D. GILMOUR & CO., INC. |
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KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
Policy contract number | 225735 |
Policy instance | 4 |
Insurance contract or identification number | 225735 | Number of Individuals Covered | 27 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $9,695 | Welfare Benefit Premiums Paid to Carrier | USD $246,557 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,695 | Insurance broker organization code? | 3 | Insurance broker name | JOHN M. GILMOUR, INC. |
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SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) |
Policy contract number | 5730855 |
Policy instance | 2 |
Insurance contract or identification number | 5730855 | Number of Individuals Covered | 35 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $951 | Total amount of fees paid to insurance company | USD $174 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,556 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $951 | Amount paid for insurance broker fees | 174 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | J. D. GILMOUR & CO., INC. |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | KM05730855 |
Policy instance | 3 |
Insurance contract or identification number | KM05730855 | Number of Individuals Covered | 84 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $8,397 | Total amount of fees paid to insurance company | USD $1,533 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,970 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,397 | Amount paid for insurance broker fees | 1533 | Additional information about fees paid to insurance broker | SALES INCENTIVE | Insurance broker organization code? | 3 | Insurance broker name | J. D. GILMOUR & CO., INC. |
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