Fidelity bond in place
Not reported
Filing
Vmware Group Health Plan
Vmware Inc. • EIN 94-3292913 • Plan year 2012
Filing Insights
Participants
Up6,338 → 7,057
719 • 11.34%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
Not reported
Participant loans in default
Not reported
Leases in default
Not reported
Reportable party-in-interest issues
Not reported
Loss discovered during year
Not reported
Assets with undetermined value
Not reported
Non-cash contributions
Not reported
Assets held for investment
Not reported
5% transactions reported
Not reported
All plan assets distributed
Not reported
Benefits paid when due
Not reported
Plan blackout period
Not reported
Plan termination resolution adopted
Not reported
Counterparties
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2024 | 1 | 0 | $0 | $0 | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 0 | - | - | - |
| 2023 | 4 | 13,842 | $0 | $807,839 | $58iApproximate average salary by contribution assumption: employee only about $1,459 at 4% or $973 at 6%; with 50% employer match about $973 at 4% or $648 at 6%; with 100% employer match about $730 at 4% or $486 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 0 | - | - | - |
| Vmware Group Health Plan | - | 0 | - | - | - |
| Vmware Inc. 401(K) Savings Plan | - | 0 | - | $807,839 | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 13,842 | - | - | - |
| 2022 | 4 | 15,375 | $3,249,879,287 | $484,772,258 | $31,530iApproximate average salary by contribution assumption: employee only about $788,248 at 4% or $525,498 at 6%; with 50% employer match about $525,498 at 4% or $350,332 at 6%; with 100% employer match about $394,124 at 4% or $262,749 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 15,375 | $3,249,879,287 | $484,772,258 | $31,530iApproximate average salary by contribution assumption: employee only about $788,248 at 4% or $525,498 at 6%; with 50% employer match about $525,498 at 4% or $350,332 at 6%; with 100% employer match about $394,124 at 4% or $262,749 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 2,630 | - | - | - |
| Vmware Group Health Plan | - | 13,971 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 13,971 | - | - | - |
| 2021 | 4 | 15,793 | $3,753,499,882 | $488,370,458 | $30,923iApproximate average salary by contribution assumption: employee only about $773,081 at 4% or $515,387 at 6%; with 50% employer match about $515,387 at 4% or $343,591 at 6%; with 100% employer match about $386,540 at 4% or $257,694 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 15,793 | $3,753,499,882 | $488,370,458 | $30,923iApproximate average salary by contribution assumption: employee only about $773,081 at 4% or $515,387 at 6%; with 50% employer match about $515,387 at 4% or $343,591 at 6%; with 100% employer match about $386,540 at 4% or $257,694 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 2,931 | - | - | - |
| Vmware Group Health Plan | - | 15,776 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 15,776 | - | - | - |
| 2020 | 4 | 15,328 | $3,094,389,578 | $402,947,189 | $26,288iApproximate average salary by contribution assumption: employee only about $657,208 at 4% or $438,138 at 6%; with 50% employer match about $438,138 at 4% or $292,092 at 6%; with 100% employer match about $328,604 at 4% or $219,069 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 15,328 | $3,094,389,578 | $402,947,189 | $26,288iApproximate average salary by contribution assumption: employee only about $657,208 at 4% or $438,138 at 6%; with 50% employer match about $438,138 at 4% or $292,092 at 6%; with 100% employer match about $328,604 at 4% or $219,069 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 2,839 | - | - | - |
| Vmware Group Health Plan | - | 15,313 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 15,313 | - | - | - |
| 2019 | 4 | 13,250 | $2,212,227,400 | $361,216,156 | $27,262iApproximate average salary by contribution assumption: employee only about $681,540 at 4% or $454,360 at 6%; with 50% employer match about $454,360 at 4% or $302,907 at 6%; with 100% employer match about $340,770 at 4% or $227,180 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 13,250 | $2,212,227,400 | $361,216,156 | $27,262iApproximate average salary by contribution assumption: employee only about $681,540 at 4% or $454,360 at 6%; with 50% employer match about $454,360 at 4% or $302,907 at 6%; with 100% employer match about $340,770 at 4% or $227,180 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 2,673 | - | - | - |
| Vmware Group Health Plan | - | 13,165 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 13,165 | - | - | - |
| 2018 | 4 | 10,914 | $1,561,888,136 | $263,931,468 | $24,183iApproximate average salary by contribution assumption: employee only about $604,571 at 4% or $403,047 at 6%; with 50% employer match about $403,047 at 4% or $268,698 at 6%; with 100% employer match about $302,285 at 4% or $201,524 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 10,914 | $1,561,888,136 | $263,931,468 | $24,183iApproximate average salary by contribution assumption: employee only about $604,571 at 4% or $403,047 at 6%; with 50% employer match about $403,047 at 4% or $268,698 at 6%; with 100% employer match about $302,285 at 4% or $201,524 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 2,586 | - | - | - |
| Vmware Group Health Plan | - | 10,901 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 10,901 | - | - | - |
| 2017 | 4 | 10,062 | $1,501,389,271 | $233,420,864 | $23,198iApproximate average salary by contribution assumption: employee only about $579,956 at 4% or $386,638 at 6%; with 50% employer match about $386,638 at 4% or $257,758 at 6%; with 100% employer match about $289,978 at 4% or $193,319 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 9,433 | $1,501,389,271 | $233,420,864 | $24,745iApproximate average salary by contribution assumption: employee only about $618,628 at 4% or $412,419 at 6%; with 50% employer match about $412,419 at 4% or $274,946 at 6%; with 100% employer match about $309,314 at 4% or $206,209 at 6%. |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 10,062 | - | - | - |
| Vmware Group Health Plan | - | 10,062 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 2,766 | - | - | - |
| 2016 | 5 | 9,866 | $1,122,553,468 | $202,962,503 | $20,572iApproximate average salary by contribution assumption: employee only about $514,298 at 4% or $342,865 at 6%; with 50% employer match about $342,865 at 4% or $228,577 at 6%; with 100% employer match about $257,149 at 4% or $171,433 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 9,866 | $1,122,553,468 | $202,962,503 | $20,572iApproximate average salary by contribution assumption: employee only about $514,298 at 4% or $342,865 at 6%; with 50% employer match about $342,865 at 4% or $228,577 at 6%; with 100% employer match about $257,149 at 4% or $171,433 at 6%. |
| Vmware Group Health Plan | - | 9,388 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 3,533 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 9,388 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 9,388 | - | - | - |
| 2015 | 4 | 9,550 | $929,307,932 | $193,876,411 | $20,301iApproximate average salary by contribution assumption: employee only about $507,530 at 4% or $338,353 at 6%; with 50% employer match about $338,353 at 4% or $225,569 at 6%; with 100% employer match about $253,765 at 4% or $169,177 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 9,550 | $929,307,932 | $193,876,411 | $20,301iApproximate average salary by contribution assumption: employee only about $507,530 at 4% or $338,353 at 6%; with 50% employer match about $338,353 at 4% or $225,569 at 6%; with 100% employer match about $253,765 at 4% or $169,177 at 6%. |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 7,959 | - | - | - |
| Vmware Group Health Plan | - | 7,959 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 3,877 | - | - | - |
| 2014 | 4 | 9,606 | $814,750,855 | $163,973,520 | $17,070iApproximate average salary by contribution assumption: employee only about $426,748 at 4% or $284,498 at 6%; with 50% employer match about $284,498 at 4% or $189,666 at 6%; with 100% employer match about $213,374 at 4% or $142,249 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 9,606 | $814,750,855 | $163,973,520 | $17,070iApproximate average salary by contribution assumption: employee only about $426,748 at 4% or $284,498 at 6%; with 50% employer match about $284,498 at 4% or $189,666 at 6%; with 100% employer match about $213,374 at 4% or $142,249 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 3,905 | - | - | - |
| Vmware Inc. 2016 Involuntary Separation Plan | - | 7,739 | - | - | - |
| Vmware Group Health Plan | - | 7,759 | - | - | - |
| 2013 | 3 | 7,293 | $655,275,005 | $128,777,800 | $17,658iApproximate average salary by contribution assumption: employee only about $441,443 at 4% or $294,295 at 6%; with 50% employer match about $294,295 at 4% or $196,197 at 6%; with 100% employer match about $220,722 at 4% or $147,148 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 7,293 | $655,275,005 | $128,777,800 | $17,658iApproximate average salary by contribution assumption: employee only about $441,443 at 4% or $294,295 at 6%; with 50% employer match about $294,295 at 4% or $196,197 at 6%; with 100% employer match about $220,722 at 4% or $147,148 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 3,296 | - | - | - |
| Vmware Group Health Plan | - | 7,052 | - | - | - |
| 2012 | 3 | 7,262 | $473,953,489 | $125,568,334 | $17,291iApproximate average salary by contribution assumption: employee only about $432,279 at 4% or $288,186 at 6%; with 50% employer match about $288,186 at 4% or $192,124 at 6%; with 100% employer match about $216,139 at 4% or $144,093 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 7,262 | $473,953,489 | $125,568,334 | $17,291iApproximate average salary by contribution assumption: employee only about $432,279 at 4% or $288,186 at 6%; with 50% employer match about $288,186 at 4% or $192,124 at 6%; with 100% employer match about $216,139 at 4% or $144,093 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 3,449 | - | - | - |
| Vmware Group Health Plan | Current | 7,057 | - | - | - |
| 2011 | 3 | 7,061 | $325,460,238 | $93,619,103 | $13,259iApproximate average salary by contribution assumption: employee only about $331,465 at 4% or $220,977 at 6%; with 50% employer match about $220,977 at 4% or $147,318 at 6%; with 100% employer match about $165,733 at 4% or $110,488 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 7,061 | $325,460,238 | $93,619,103 | $13,259iApproximate average salary by contribution assumption: employee only about $331,465 at 4% or $220,977 at 6%; with 50% employer match about $220,977 at 4% or $147,318 at 6%; with 100% employer match about $165,733 at 4% or $110,488 at 6%. |
| Vmware Group Health Plan | - | 6,338 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 2,844 | - | - | - |
| 2010 | 4 | 5,122 | $262,265,135 | $69,251,709 | $13,520iApproximate average salary by contribution assumption: employee only about $338,011 at 4% or $225,341 at 6%; with 50% employer match about $225,341 at 4% or $150,227 at 6%; with 100% employer match about $169,006 at 4% or $112,670 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 5,122 | $261,957,064 | $69,251,709 | $13,520iApproximate average salary by contribution assumption: employee only about $338,011 at 4% or $225,341 at 6%; with 50% employer match about $225,341 at 4% or $150,227 at 6%; with 100% employer match about $169,006 at 4% or $112,670 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 31 | $308,071 | - | - |
| Vmware Inc. Flexible Spending Plan | - | 2,452 | - | - | - |
| Vmware Group Health Plan | - | 3,785 | - | - | - |
| 2009 | 7 | 4,226 | $449,014,086 | $126,739,465 | $29,990iApproximate average salary by contribution assumption: employee only about $749,760 at 4% or $499,840 at 6%; with 50% employer match about $499,840 at 4% or $333,227 at 6%; with 100% employer match about $374,880 at 4% or $249,920 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 4,076 | $174,025,603 | $43,266,092 | $10,615iApproximate average salary by contribution assumption: employee only about $265,371 at 4% or $176,914 at 6%; with 50% employer match about $176,914 at 4% or $117,943 at 6%; with 100% employer match about $132,686 at 4% or $88,457 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 4,076 | $174,025,603 | $43,266,092 | $10,615iApproximate average salary by contribution assumption: employee only about $265,371 at 4% or $176,914 at 6%; with 50% employer match about $176,914 at 4% or $117,943 at 6%; with 100% employer match about $132,686 at 4% or $88,457 at 6%. |
| Vmware Inc. 401(K) Savings Plan | - | 4,213 | $100,962,880 | $40,207,281 | $9,544iApproximate average salary by contribution assumption: employee only about $238,591 at 4% or $159,060 at 6%; with 50% employer match about $159,060 at 4% or $106,040 at 6%; with 100% employer match about $119,295 at 4% or $79,530 at 6%. |
| Vmware Inc. Flexible Spending Plan | - | 1,843 | - | - | - |
| VMWARE, INC. JANUARY 2009 TRANSITION PAY PLAN | - | 0 | - | - | - |
| Akimbi Systems Inc Retirement Trust | - | - | - | - | - |
| Vmware Group Health Plan | - | 4,226 | - | - | - |
| 2008 | 3 | 4,049 | $0 | $0 | - |
| Vmware Group Health Plan | - | 4,049 | - | - | - |
| Akimbi Systems Inc Retirement Trust | - | 0 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 1,749 | - | - | - |
| 2007 | 3 | 3,572 | $0 | $0 | - |
| Vmware Group Health Plan | - | 3,572 | - | - | - |
| Vmware Inc. Flexible Spending Plan | - | 1,276 | - | - | - |
| Akimbi Systems Inc Retirement Trust | - | 31 | - | - | - |
| 2006 | 1 | 2,032 | $0 | $0 | - |
| Vmware Group Health Plan | - | 2,032 | - | - | - |
| 2005 | 1 | 421 | $0 | $0 | - |
| Vmware Inc. Flexible Spending Plan | - | 421 | - | - | - |
| 2004 | 1 | 745 | $0 | $0 | - |
| Vmware Group Health Plan | - | 745 | - | - | - |
| 2003 | 2 | 423 | $6,010,308 | $2,750,594 | $6,503iApproximate average salary by contribution assumption: employee only about $162,565 at 4% or $108,376 at 6%; with 50% employer match about $108,376 at 4% or $72,251 at 6%; with 100% employer match about $81,282 at 4% or $54,188 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 386 | $6,010,308 | $2,750,594 | $7,126iApproximate average salary by contribution assumption: employee only about $178,147 at 4% or $118,765 at 6%; with 50% employer match about $118,765 at 4% or $79,177 at 6%; with 100% employer match about $89,074 at 4% or $59,382 at 6%. |
| Vmware Group Health Plan | - | 423 | - | - | - |
| 2002 | 3 | 270 | $2,504,471 | $1,647,509 | $6,102iApproximate average salary by contribution assumption: employee only about $152,547 at 4% or $101,698 at 6%; with 50% employer match about $101,698 at 4% or $67,799 at 6%; with 100% employer match about $76,274 at 4% or $50,849 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 177 | $2,504,471 | $1,647,509 | $9,308iApproximate average salary by contribution assumption: employee only about $232,699 at 4% or $155,133 at 6%; with 50% employer match about $155,133 at 4% or $103,422 at 6%; with 100% employer match about $116,350 at 4% or $77,566 at 6%. |
| Vmware Group Health Plan | - | 270 | - | - | - |
| Vmware Inc. Life and Ltd Plan | - | 0 | - | - | - |
| 2001 | 3 | 182 | $1,491,688 | $961,186 | $5,281iApproximate average salary by contribution assumption: employee only about $132,031 at 4% or $88,021 at 6%; with 50% employer match about $88,021 at 4% or $58,680 at 6%; with 100% employer match about $66,016 at 4% or $44,010 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 180 | $1,491,688 | $961,186 | $5,340iApproximate average salary by contribution assumption: employee only about $133,498 at 4% or $88,999 at 6%; with 50% employer match about $88,999 at 4% or $59,332 at 6%; with 100% employer match about $66,749 at 4% or $44,499 at 6%. |
| Vmware Inc. Life and Ltd Plan | - | 168 | - | - | - |
| Vmware Group Health Plan | - | 182 | - | - | - |
| 2000 | 3 | 115 | $720,491 | $530,974 | $4,617iApproximate average salary by contribution assumption: employee only about $115,429 at 4% or $76,953 at 6%; with 50% employer match about $76,953 at 4% or $51,302 at 6%; with 100% employer match about $57,715 at 4% or $38,476 at 6%. |
| Akimbi Systems Inc Retirement Trust | - | 107 | $720,491 | $530,974 | $4,962iApproximate average salary by contribution assumption: employee only about $124,059 at 4% or $82,706 at 6%; with 50% employer match about $82,706 at 4% or $55,137 at 6%; with 100% employer match about $62,030 at 4% or $41,353 at 6%. |
| Vmware Inc. Life and Ltd Plan | - | 115 | - | - | - |
| Vmware Group Health Plan | - | 108 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Form Id
- 1
- Ins Broker Name
- MERCER HEALTH & BENEFITS, LLC
- Ins Broker US Address1
- 1166 AVENUE OF THE AMERICAS
- Ins Broker US City
- NEW YORK
- Ins Broker US State
- NY
- Ins Broker US ZIP
- 10036
- Ins Broker Comm Pd Amount
- $891
- Ins Broker Code
- 3
- Row 2
- Form Id
- 9
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES
- Ins Broker US Address1
- 1039 N MCDOWELL BLVD
- Ins Broker US Address2
- STE A
- Ins Broker US City
- PETALUMA
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94954
- Ins Broker Comm Pd Amount
- $5,187
- Ins Broker Code
- 7
- Row 3
- Form Id
- 8
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES
- Ins Broker US Address1
- 1039 N MCDOWELL BLVD
- Ins Broker US Address2
- STE A
- Ins Broker US City
- PETALUMA
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94954
- Ins Broker Comm Pd Amount
- $1,988
- Ins Broker Code
- 7
- Row 4
- Form Id
- 7
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES
- Ins Broker US Address1
- 1039 N MCDOWELL BLVD, STE A
- Ins Broker US City
- PETALUMA
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94954
- Ins Broker Comm Pd Amount
- $17,881
- Ins Broker Code
- 7
- Row 5
- Form Id
- 6
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES USA
- Ins Broker US Address1
- 959 SKYWAY ROAD, 2ND FLOOR
- Ins Broker US City
- SAN CARLOS
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94070
- Ins Broker Comm Pd Amount
- $17,706
- Ins Broker Code
- 3
- Row 6
- Form Id
- 5
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES
- Ins Broker US Address1
- 959 SKYWAY ROAD, 2ND FLOOR
- Ins Broker US City
- SAN CARLOS
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94070
- Ins Broker Comm Pd Amount
- $5,099
- Ins Broker Code
- 3
- Row 7
- Form Id
- 4
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA, INC
- Ins Broker US Address1
- LOCKBOX #9102 P.O. BOX 8500
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $23,317
- Ins Broker Code
- 3
- Row 8
- Form Id
- 3
- Ins Broker Name
- WELLS FARGO INSURANCE SERVICES USA
- Ins Broker US Address1
- 150 N MICHIGAN AVE STE 3900
- Ins Broker US City
- CHICAGO
- Ins Broker US State
- IL
- Ins Broker US ZIP
- 606017604
- Ins Broker Comm Pd Amount
- $93,277
- Ins Broker Fees Pd Amount
- $833
- Ins Broker Fees Pd Text
- BONUS
- Ins Broker Code
- 3
- Row 9
- Form Id
- 2
- Ins Broker US Address1
- WELLS FARGO INSURANCE SERVICES
- Ins Broker US Address2
- 1039 N MCDOWELL BLVD, STE A
- Ins Broker US City
- PETALUMA
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94954
- Ins Broker Comm Pd Amount
- $32,720
- Ins Broker Code
- 7
- Row 10
- Form Id
- 9
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA, INC.
- Ins Broker US Address1
- PO BOX #8500
- Ins Broker US Address2
- LOCK BOX #9102
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $3,364
- Ins Broker Code
- 7
- Row 11
- Form Id
- 2
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA
- Ins Broker US Address1
- PO BOX 8500
- Ins Broker US Address2
- LOCK BOX 9102
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $22,496
- Ins Broker Code
- 7
- Row 12
- Form Id
- 3
- Ins Broker Name
- TOWERS WATSON, PA
- Ins Broker US Address1
- LOCKBOX #9102, P.O. BOX 8500
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 191780001
- Ins Broker Comm Pd Amount
- $62,224
- Ins Broker Fees Pd Amount
- $0
- Ins Broker Code
- 3
- Row 13
- Form Id
- 4
- Ins Broker Name
- ABD INSURANCE AND FINANCIAL SERVICE
- Ins Broker US Address1
- 959 SKYWAY ROAD 2ND FLOOR
- Ins Broker US City
- SAN CARLOS
- Ins Broker US State
- CA
- Ins Broker US ZIP
- 94070
- Ins Broker Comm Pd Amount
- $21,034
- Ins Broker Code
- 3
- Row 14
- Form Id
- 5
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA, INC.
- Ins Broker US Address1
- LOCKBOX #9102 P.O. BOX 8500
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $2,906
- Ins Broker Code
- 3
- Row 15
- Form Id
- 6
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA, INC.
- Ins Broker US Address1
- LOCKBOX #9102 PO BOX 8500
- Ins Broker US City
- PHILADELPHIA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $11,549
- Ins Broker Code
- 3
- Row 16
- Form Id
- 7
- Ins Broker Name
- TOWERS WATSON PENNSYLVANIA, INC.
- Ins Broker US Address1
- PO BOX 8500
- Ins Broker US Address2
- LOCK BOX 9102
- Ins Broker US City
- PHILADELPIHA
- Ins Broker US State
- PA
- Ins Broker US ZIP
- 19178
- Ins Broker Comm Pd Amount
- $9,479
- Ins Broker Code
- 7
- Row 17
- Ins Carrier Name: ARAG INSURANCE COMPANY
- Form Id
- 6
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- ARAG INSURANCE COMPANY
- Ins Carrier EIN
- 42-1338303
- Ins Carrier Naic Code
- 34738
- Ins Contract Num
- 16121-001
- Ins Prsn Covered End of year Count
- 1,539
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $29,255
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- LEGAL
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $292,552
- Ins Fail Provide Info Indicator
- Yes
- Ins Fail Provide Info Text
- BENEFIT TYPE
- Row 18
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN INC.
- Form Id
- 3
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN INC.
- Ins Carrier EIN
- 94-1340523
- Ins Carrier Naic Code
- 00000
- Ins Contract Num
- 39501
- Ins Prsn Covered End of year Count
- 1,794
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $155,501
- Ins Broker Fees Total Amount
- $833
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $6,159,873
- Ins Fail Provide Info Indicator
- Yes
- Ins Fail Provide Info Text
- ORGANIZATION CODE AND TYPE OF BENEFIT
- Row 19
- Ins Carrier Name: CONCERN - EAP
- Form Id
- 5
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- CONCERN - EAP
- Ins Carrier EIN
- 77-0528349
- Ins Carrier Naic Code
- 00000
- Ins Contract Num
- 988
- Ins Prsn Covered End of year Count
- 7,057
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $8,005
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- EMPLOYEE ASSISTANCE PROGRAM
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $160,113
- Ins Fail Provide Info Indicator
- Yes
- Ins Fail Provide Info Text
- ADDRESS OF VENDOR AND ORGANIZATION CODES
- Row 20
- Ins Carrier Name: LIFE INSURANCE COMPANY OF NORTH AMERICA
- Form Id
- 9
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- LIFE INSURANCE COMPANY OF NORTH AMERICA
- Ins Carrier EIN
- 23-1503749
- Ins Carrier Naic Code
- 65498
- Ins Contract Num
- OK964094
- Ins Prsn Covered End of year Count
- 7,057
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $8,551
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- ACCIDENTAL DEATH & DISMEMBERMENT
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $285,024
- Ins Fail Provide Info Indicator
- No
- Row 21
- Ins Carrier Name: LIFE INSURANCE COMPANY OF NORTH AMERICA
- Form Id
- 2
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- LIFE INSURANCE COMPANY OF NORTH AMERICA
- Ins Carrier EIN
- 23-1503749
- Ins Carrier Naic Code
- 65498
- Ins Contract Num
- FLX962456
- Ins Prsn Covered End of year Count
- 4,879
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $55,216
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- Yes
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- BASIC LIFE, SUPPLEMENTAL LIFE, DEPENDENT LIFE
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $1,844,015
- Ins Fail Provide Info Indicator
- No
- Row 22
- Ins Carrier Name: LIFE INSURANCE COMPANY OF NORTH AMERICA
- Form Id
- 8
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- LIFE INSURANCE COMPANY OF NORTH AMERICA
- Ins Carrier EIN
- 23-1503749
- Ins Carrier Naic Code
- 65498
- Ins Contract Num
- LK961804
- Ins Prsn Covered End of year Count
- 7,057
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $1,988
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- Yes
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $1,162,159
- Ins Fail Provide Info Indicator
- No
- Row 23
- Ins Carrier Name: TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC.
- Form Id
- 4
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC.
- Ins Carrier EIN
- 04-2674079
- Ins Carrier Naic Code
- 95688
- Ins Contract Num
- 61779000
- Ins Prsn Covered End of year Count
- 115
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $44,351
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $1,573,294
- Ins Fail Provide Info Indicator
- No
- Row 24
- Ins Carrier Name: LIFE INSURANCE COMPANY OF NORTH AMERICA
- Form Id
- 7
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- LIFE INSURANCE COMPANY OF NORTH AMERICA
- Ins Carrier EIN
- 23-1503749
- Ins Carrier Naic Code
- 65498
- Ins Contract Num
- FLX962455
- Ins Prsn Covered End of year Count
- 7,061
- Ins Policy From Date
- 2012-05-01
- Ins Policy To Date
- 2013-04-30
- Ins Broker Comm Total Amount
- $27,360
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- Yes
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $916,556
- Ins Fail Provide Info Indicator
- No
- Row 25
- Ins Carrier Name: GERBER LIFE & ACCIDENT INSURANCE COMPANY
- Form Id
- 1
- Schedule A Plan Year Begin Date
- 2012-05-01
- Schedule A Plan Year End Date
- 2013-04-30
- Schedule A Plan Num
- 503
- Schedule A EIN
- 94-3292913
- Ins Carrier Name
- GERBER LIFE & ACCIDENT INSURANCE COMPANY
- Ins Carrier EIN
- 13-2611847
- Ins Carrier Naic Code
- 70939
- Ins Contract Num
- BTA119785
- Ins Prsn Covered End of year Count
- 7,057
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $891
- Ins Broker Fees Total Amount
- $0
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- BUSINESS TRAVEL ACCIDENT
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $4,455
- Ins Fail Provide Info Indicator
- Yes
- Ins Fail Provide Info Text
- ORGANIZATION CODE AND CERTIFICATION PROVIDED WAS UNSIGNED
Filing received by DOL Nov 14, 2013