FCA US LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES
401k plan membership statisitcs for FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES
| Measure | Date | Value |
|---|
| 2023: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 11,587 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 10,969 |
| Total of all active and inactive participants | 2023-01-01 | 10,969 |
| 2022: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 12,320 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 11,587 |
| Total of all active and inactive participants | 2022-01-01 | 11,587 |
| 2021: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 13,212 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 12,320 |
| Total of all active and inactive participants | 2021-01-01 | 12,320 |
| 2020: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 13,119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 13,212 |
| Total of all active and inactive participants | 2020-01-01 | 13,212 |
| 2019: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 12,894 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 13,119 |
| Total of all active and inactive participants | 2019-01-01 | 13,119 |
| 2017: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 12,597 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 12,987 |
| Total of all active and inactive participants | 2017-01-01 | 12,987 |
| 2016: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 11,909 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 12,597 |
| Total of all active and inactive participants | 2016-01-01 | 12,597 |
| 2015: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 11,685 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 11,909 |
| Total of all active and inactive participants | 2015-01-01 | 11,909 |
| 2014: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 10,448 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 11,685 |
| Total of all active and inactive participants | 2014-01-01 | 11,685 |
| 2013: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 9,864 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 10,448 |
| Total of all active and inactive participants | 2013-01-01 | 10,448 |
| 2012: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 8,801 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 9,864 |
| Total of all active and inactive participants | 2012-01-01 | 9,864 |
| 2009: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 33,024 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 6,910 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 20,433 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 27,343 |
| Measure | Date | Value |
|---|
| 2010 : FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2010 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $7,188,758 |
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $7,188,758 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $6,553,100 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $5,389,500 |
| Total income from all sources (including contributions) | 2010-12-31 | $191,856,484 |
| Total loss/gain on sale of assets | 2010-12-31 | $1,087,323 |
| Total of all expenses incurred | 2010-12-31 | $186,086,657 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $172,580,214 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $179,668,014 |
| Value of total assets at end of year | 2010-12-31 | $133,979,108 |
| Value of total assets at beginning of year | 2010-12-31 | $127,045,681 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $13,506,443 |
| Total interest from all sources | 2010-12-31 | $2,357,393 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2010-12-31 | $65,855 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2010-12-31 | $25,611 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $30,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $22,040,667 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2010-12-31 | $14,955,942 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $377,432 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $351,170 |
| Assets. Loans (other than to participants) at end of year | 2010-12-31 | $24,247,581 |
| Administrative expenses (other) incurred | 2010-12-31 | $6,213,230 |
| Total non interest bearing cash at end of year | 2010-12-31 | $8,324 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $27,861 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $5,769,827 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $127,426,008 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $121,656,181 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2010-12-31 | $71,159,912 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $58,678,092 |
| Value of interest in pooled separate accounts at beginning of year | 2010-12-31 | $59,565,683 |
| Interest earned on other investments | 2010-12-31 | $1,501,417 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $29,977 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $1,909,421 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $1,909,421 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $855,976 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2010-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2010-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $146,372,519 |
| Asset value of US Government securities at end of year | 2010-12-31 | $24,931,143 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2010-12-31 | $1,554,996 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Assets. Invements in employer securities at end of year | 2010-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2010-12-31 | $0 |
| Contributions received in cash from employer | 2010-12-31 | $157,627,347 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $11,251,753 |
| Asset. Corporate debt instrument debt (other) at end of year | 2010-12-31 | $5,282,692 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2010-12-31 | $8,341 |
| Contract administrator fees | 2010-12-31 | $7,293,213 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2010-12-31 | $7,876,192 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2010-12-31 | $6,479,502 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $6,553,100 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $5,389,500 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Aggregate proceeds on sale of assets | 2010-12-31 | $28,900,198 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $27,812,875 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | PLANTE & MORAN, PLLC |
| Accountancy firm EIN | 2010-12-31 | 381357971 |
| 2023: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: FCA US LLC HEALTH CARE BENEFITS PLAN FOR SALARIED NON-REPRESENTED EMPLOYEES 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 4 |
| Insurance contract or identification number | 750 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 3 |
| Insurance contract or identification number | 728 | | Number of Individuals Covered | 1148 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $313,357 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 2 |
| Insurance contract or identification number | 756 | | Number of Individuals Covered | 28545 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $10,475,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| Insurance contract or identification number | 732 | | Number of Individuals Covered | 964 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $339,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 638 |
| Policy instance | 5 |
| Insurance contract or identification number | 638 | | Number of Individuals Covered | 29266 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $692,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| Insurance contract or identification number | 732 | | Number of Individuals Covered | 1072 | | 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 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $346,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYE-MED (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 672 |
| Policy instance | 2 |
| Insurance contract or identification number | 672 | | Number of Individuals Covered | 31006 | | 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 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,130,846 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| Insurance contract or identification number | 756 | | Number of Individuals Covered | 30301 | | 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 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $10,960,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 4 |
| Insurance contract or identification number | 728 | | Number of Individuals Covered | 1269 | | 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 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $336,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 5 |
| Insurance contract or identification number | 750 | | Number of Individuals Covered | 26 | | 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 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYE-MED (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 672 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 5 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| EYE-MED (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 672, 674 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 6 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| EYE-MED (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 672, 674 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 6 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 6 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 5 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 4 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 3 |
| EYE-MED (National Association of Insurance Commissioners NAIC id number: 11204 ) |
| Policy contract number | 672, 674 |
| Policy instance | 2 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 1 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 2 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 3 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 646 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 6 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 7 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 646 |
| Policy instance | 2 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 3 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 5 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 1 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 6 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 646 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 756 |
| Policy instance | 1 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 750 |
| Policy instance | 3 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 732 |
| Policy instance | 4 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 748 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 728 |
| Policy instance | 6 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 730 |
| Policy instance | 7 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 6071 |
| Policy instance | 2 |
| AETNA DENTAL (National Association of Insurance Commissioners NAIC id number: 11183 ) |
| Policy contract number | 0000 |
| Policy instance | 3 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 0000 |
| Policy instance | 4 |
| COOPERATIVE OPTICAL NVA (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 0000 |
| Policy instance | 5 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 202 |
| Policy instance | 6 |
| UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. (National Association of Insurance Commissioners NAIC id number: 96150 ) |
| Policy contract number | 0000 |
| Policy instance | 7 |
| MIDWESTERN DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 11107 ) |
| Policy contract number | 0000 |
| Policy instance | 1 |
