CUTLER-HAMMER ELECTRICAL CO has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN
401k plan membership statisitcs for EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,463 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,516 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 101 |
| Total of all active and inactive participants | 2022-01-01 | 1,617 |
| 2021: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,451 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,368 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 101 |
| Total of all active and inactive participants | 2021-01-01 | 1,469 |
| 2020: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,492 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,347 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 104 |
| Total of all active and inactive participants | 2020-01-01 | 1,451 |
| 2019: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,440 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,401 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 91 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 1,492 |
| 2018: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,483 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,392 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 90 |
| Total of all active and inactive participants | 2018-01-01 | 1,482 |
| 2017: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,579 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,392 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 91 |
| Total of all active and inactive participants | 2017-01-01 | 1,483 |
| 2016: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,518 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,463 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 116 |
| Total of all active and inactive participants | 2016-01-01 | 1,579 |
| 2015: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,609 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,551 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 104 |
| Total of all active and inactive participants | 2015-01-01 | 1,655 |
| 2014: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,707 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,593 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 98 |
| Total of all active and inactive participants | 2014-01-01 | 1,691 |
| 2013: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 1,825 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,626 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 81 |
| Total of all active and inactive participants | 2013-01-01 | 1,707 |
| Total participants | 2013-01-01 | 1,707 |
| 2012: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 1,590 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,825 |
| Total of all active and inactive participants | 2012-01-01 | 1,825 |
| Total participants | 2012-01-01 | 1,825 |
| 2011: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 1,527 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,519 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 71 |
| Total of all active and inactive participants | 2011-01-01 | 1,590 |
| Total participants | 2011-01-01 | 1,590 |
| 2010: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 1,623 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,429 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 98 |
| Total of all active and inactive participants | 2010-01-01 | 1,527 |
| Total participants | 2010-01-01 | 1,527 |
| 2009: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 1,803 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,450 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 173 |
| Total of all active and inactive participants | 2009-01-01 | 1,623 |
| Total participants | 2009-01-01 | 1,623 |
| 2022: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: EATON ELECTRICAL DE PUERTO RICO MEDICAL, DENTAL & LIFE INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 ) |
| Policy contract number | V2101001 |
| Policy instance | 5 |
| Insurance contract or identification number | V2101001 | | Number of Individuals Covered | 1390 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $52,397 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $477,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,397 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681535G |
| Policy instance | 4 |
| Insurance contract or identification number | 681535G | | Number of Individuals Covered | 0 | | 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 $596 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 596 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 3 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 17 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $475 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $475 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 96634771001 |
| Policy instance | 2 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 2007 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 1 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1476 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $81,480 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $169,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $81,480 | | Insurance broker organization code? | 3 |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 1 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1367 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $87,012 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $121,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,012 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 96634771001 |
| Policy instance | 2 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 1863 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 3 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 18 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $537 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,345 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $537 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681535G |
| Policy instance | 4 |
| Insurance contract or identification number | 681535G | | Number of Individuals Covered | 1414 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $9,448 | | Total amount of fees paid to insurance company | USD $4,476 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $89,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,448 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4476 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 ) |
| Policy contract number | V2101001 |
| Policy instance | 5 |
| Insurance contract or identification number | V2101001 | | Number of Individuals Covered | 1340 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $60,290 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $502,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,290 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681535G |
| Policy instance | 4 |
| Insurance contract or identification number | 681535G | | Number of Individuals Covered | 1414 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $59,797 | | Total amount of fees paid to insurance company | USD $28,323 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $566,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,797 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 28323 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 3 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 17 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $636 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $636 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 96634771001 |
| Policy instance | 2 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 1842 | | 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 $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 1 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1357 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $64,812 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $124,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $64,812 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 96634771001 |
| Policy instance | 2 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 1875 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 1 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1411 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $48,637 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $127,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,990 | | Insurance broker organization code? | 3 |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 3 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 17 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $666 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $608 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681535G |
| Policy instance | 4 |
| Insurance contract or identification number | 681535G | | Number of Individuals Covered | 1479 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $38,507 | | Total amount of fees paid to insurance company | USD $38,204 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $363,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 45320 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $38,507 |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 5 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 ) |
| Policy contract number | V07325 |
| Policy instance | 1 |
| Insurance contract or identification number | V07325 | | Number of Individuals Covered | 1380 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $422,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 2 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1421 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $101,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 96634771001 |
| Policy instance | 3 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 1817 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FHCHS HEALTH SYSTEMS, INC. (National Association of Insurance Commissioners NAIC id number: 62111 ) |
| Policy contract number | FHCHS-001 |
| Policy instance | 4 |
| Insurance contract or identification number | FHCHS-001 | | Number of Individuals Covered | 1550 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $82,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000RET |
| Policy instance | 5 |
| Insurance contract or identification number | SP0004000RET | | Number of Individuals Covered | 23 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $1,388 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FHCHS HEALTH SYSTEMS, INC. (National Association of Insurance Commissioners NAIC id number: 62111 ) |
| Policy contract number | FHCHS-001 |
| Policy instance | 4 |
| Insurance contract or identification number | FHCHS-001 | | Number of Individuals Covered | 1550 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EAP | | Welfare Benefit Premiums Paid to Carrier | USD $78,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 96634771001 |
| Policy instance | 3 |
| Insurance contract or identification number | 96634771001 | | Number of Individuals Covered | 1908 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 ) |
| Policy contract number | SP0004000 |
| Policy instance | 2 |
| Insurance contract or identification number | SP0004000 | | Number of Individuals Covered | 1420 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ORGAN AND TISSUE TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $108,539 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 ) |
| Policy contract number | V07325 |
| Policy instance | 1 |
| Insurance contract or identification number | V07325 | | Number of Individuals Covered | 1460 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $419,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
