JEWISH HOME OF CINCINNATI, INC. has sponsored the creation of one or more 401k plans.
Additional information about JEWISH HOME OF CINCINNATI, INC.
Submission information for form 5500 for 401k plan JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN
401k plan membership statisitcs for JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2017: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 298 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 178 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 178 |
| 2016: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 373 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 295 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 298 |
| 2015: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 242 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 242 |
| 2014: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 254 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 254 |
| 2013: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 548 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 236 |
| Number of retired or separated participants receiving benefits | 2013-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-06-01 | 0 |
| Total of all active and inactive participants | 2013-06-01 | 236 |
| 2012: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 533 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 548 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-06-01 | 0 |
| Total of all active and inactive participants | 2012-06-01 | 548 |
| 2011: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 243 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 533 |
| Number of retired or separated participants receiving benefits | 2011-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-06-01 | 0 |
| Total of all active and inactive participants | 2011-06-01 | 533 |
| 2009: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 210 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 232 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 235 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-06-01 | 0 |
| Total participants | 2009-06-01 | 235 |
| 2007: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-06-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-06-01 | 156 |
| Number of retired or separated participants receiving benefits | 2007-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-06-01 | 0 |
| Total of all active and inactive participants | 2007-06-01 | 156 |
| Total participants | 2007-06-01 | 156 |
| 2006: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-06-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-06-01 | 128 |
| Number of retired or separated participants receiving benefits | 2006-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-06-01 | 0 |
| Total of all active and inactive participants | 2006-06-01 | 128 |
| Total participants | 2006-06-01 | 128 |
| 2005: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-06-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-06-01 | 133 |
| Number of retired or separated participants receiving benefits | 2005-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-06-01 | 0 |
| Total of all active and inactive participants | 2005-06-01 | 133 |
| Total participants | 2005-06-01 | 133 |
| 2004: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-06-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-06-01 | 121 |
| Number of retired or separated participants receiving benefits | 2004-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-06-01 | 0 |
| Total of all active and inactive participants | 2004-06-01 | 121 |
| Total participants | 2004-06-01 | 121 |
| 2003: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-06-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-06-01 | 110 |
| Number of retired or separated participants receiving benefits | 2003-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-06-01 | 0 |
| Total of all active and inactive participants | 2003-06-01 | 110 |
| Total participants | 2003-06-01 | 110 |
| 2002: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-06-01 | 123 |
| Number of retired or separated participants receiving benefits | 2002-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-06-01 | 0 |
| Total of all active and inactive participants | 2002-06-01 | 123 |
| Total participants | 2002-06-01 | 123 |
| 2001: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 2001-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2001-06-01 | 0 |
| Total of all active and inactive participants | 2001-06-01 | 112 |
| Total participants | 2001-06-01 | 112 |
| 2000: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 2000-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2000-06-01 | 0 |
| Total of all active and inactive participants | 2000-06-01 | 112 |
| Total participants | 2000-06-01 | 112 |
| 1999: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1999 401k membership |
|---|
| Total participants, beginning-of-year | 1999-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 1999-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 1999-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1999-06-01 | 0 |
| Total of all active and inactive participants | 1999-06-01 | 112 |
| Total participants | 1999-06-01 | 112 |
| 1998: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 1998-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1998-06-01 | 0 |
| Total of all active and inactive participants | 1998-06-01 | 112 |
| Total participants | 1998-06-01 | 112 |
| 1997: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1997 401k membership |
|---|
| Total participants, beginning-of-year | 1997-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 1997-06-01 | 112 |
| Number of retired or separated participants receiving benefits | 1997-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1997-06-01 | 0 |
| Total of all active and inactive participants | 1997-06-01 | 112 |
| Total participants | 1997-06-01 | 112 |
| 2017: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | Submission has been amended | No |
| 2016-06-01 | This submission is the final filing | No |
| 2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-06-01 | Plan is a collectively bargained plan | No |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Submission has been amended | No |
| 2015-06-01 | This submission is the final filing | No |
| 2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-06-01 | Plan is a collectively bargained plan | No |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Submission has been amended | No |
| 2014-06-01 | This submission is the final filing | No |
| 2014-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-06-01 | Plan is a collectively bargained plan | No |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Submission has been amended | No |
| 2013-06-01 | This submission is the final filing | No |
| 2013-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-06-01 | Plan is a collectively bargained plan | No |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Submission has been amended | No |
| 2012-06-01 | This submission is the final filing | No |
| 2012-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-06-01 | Plan is a collectively bargained plan | No |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Submission has been amended | No |
| 2011-06-01 | This submission is the final filing | No |
| 2011-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-06-01 | Plan is a collectively bargained plan | No |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Submission has been amended | No |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-06-01 | Plan is a collectively bargained plan | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2007 form 5500 responses |
|---|
| 2007-06-01 | Type of plan entity | Single employer plan |
| 2007-06-01 | Submission has been amended | No |
| 2007-06-01 | This submission is the final filing | No |
| 2007-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-06-01 | Plan is a collectively bargained plan | No |
| 2007-06-01 | Plan funding arrangement – Insurance | Yes |
| 2007-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2006 form 5500 responses |
|---|
| 2006-06-01 | Type of plan entity | Single employer plan |
| 2006-06-01 | Submission has been amended | No |
| 2006-06-01 | This submission is the final filing | No |
| 2006-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-06-01 | Plan is a collectively bargained plan | No |
| 2006-06-01 | Plan funding arrangement – Insurance | Yes |
| 2006-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2005 form 5500 responses |
|---|
| 2005-06-01 | Type of plan entity | Single employer plan |
| 2005-06-01 | Submission has been amended | No |
| 2005-06-01 | This submission is the final filing | No |
| 2005-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-06-01 | Plan is a collectively bargained plan | No |
| 2005-06-01 | Plan funding arrangement – Insurance | Yes |
| 2005-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2004 form 5500 responses |
|---|
| 2004-06-01 | Type of plan entity | Single employer plan |
| 2004-06-01 | Submission has been amended | No |
| 2004-06-01 | This submission is the final filing | No |
| 2004-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-06-01 | Plan is a collectively bargained plan | No |
| 2004-06-01 | Plan funding arrangement – Insurance | Yes |
| 2004-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2003 form 5500 responses |
|---|
| 2003-06-01 | Type of plan entity | Single employer plan |
| 2003-06-01 | Submission has been amended | No |
| 2003-06-01 | This submission is the final filing | No |
| 2003-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-06-01 | Plan is a collectively bargained plan | No |
| 2003-06-01 | Plan funding arrangement – Insurance | Yes |
| 2003-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2002 form 5500 responses |
|---|
| 2002-06-01 | Type of plan entity | Single employer plan |
| 2002-06-01 | Submission has been amended | No |
| 2002-06-01 | This submission is the final filing | No |
| 2002-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-06-01 | Plan is a collectively bargained plan | No |
| 2002-06-01 | Plan funding arrangement – Insurance | Yes |
| 2002-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2001 form 5500 responses |
|---|
| 2001-06-01 | Type of plan entity | Single employer plan |
| 2001-06-01 | Submission has been amended | No |
| 2001-06-01 | This submission is the final filing | No |
| 2001-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-06-01 | Plan is a collectively bargained plan | No |
| 2001-06-01 | Plan funding arrangement – Insurance | Yes |
| 2001-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2000: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 2000 form 5500 responses |
|---|
| 2000-06-01 | Type of plan entity | Single employer plan |
| 2000-06-01 | Submission has been amended | No |
| 2000-06-01 | This submission is the final filing | No |
| 2000-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2000-06-01 | Plan is a collectively bargained plan | No |
| 2000-06-01 | Plan funding arrangement – Insurance | Yes |
| 2000-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1999: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1999 form 5500 responses |
|---|
| 1999-06-01 | Type of plan entity | Single employer plan |
| 1999-06-01 | Submission has been amended | No |
| 1999-06-01 | This submission is the final filing | No |
| 1999-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1999-06-01 | Plan is a collectively bargained plan | No |
| 1999-06-01 | Plan funding arrangement – Insurance | Yes |
| 1999-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1998: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1998 form 5500 responses |
|---|
| 1998-06-01 | Type of plan entity | Single employer plan |
| 1998-06-01 | Submission has been amended | No |
| 1998-06-01 | This submission is the final filing | No |
| 1998-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1998-06-01 | Plan is a collectively bargained plan | No |
| 1998-06-01 | Plan funding arrangement – Insurance | Yes |
| 1998-06-01 | Plan benefit arrangement – Insurance | Yes |
| 1997: JEWISH HOME OF CINCINNATI, INC. HEALTH AND WELFARE PLAN 1997 form 5500 responses |
|---|
| 1997-06-01 | Type of plan entity | Single employer plan |
| 1997-06-01 | Submission has been amended | No |
| 1997-06-01 | This submission is the final filing | No |
| 1997-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1997-06-01 | Plan is a collectively bargained plan | No |
| 1997-06-01 | Plan funding arrangement – Insurance | Yes |
| 1997-06-01 | Plan benefit arrangement – Insurance | Yes |
| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 6810201 |
| Policy instance | 4 |
| Insurance contract or identification number | 6810201 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $5,730 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,730 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 169820 |
| Policy instance | 3 |
| Insurance contract or identification number | 169820 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $9,369 | | Total amount of fees paid to insurance company | USD $3,117 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $101,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $9,369 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,107 | | Total amount of fees paid to insurance company | USD $252 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,107 | | Amount paid for insurance broker fees | 51 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10002501001 |
| Policy instance | 1 |
| Insurance contract or identification number | 10002501001 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,865 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,865 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 1000250 |
| Policy instance | 4 |
| Insurance contract or identification number | 1000250 | | Number of Individuals Covered | 304 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,048 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 $20,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $2,048 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES, LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $3,020 | | Total amount of fees paid to insurance company | USD $275 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,020 | | Amount paid for insurance broker fees | 275 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES, LLC |
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| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 6810201 |
| Policy instance | 2 |
| Insurance contract or identification number | 6810201 | | Number of Individuals Covered | 355 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $6,808 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,808 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES, LLC |
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 169820 |
| Policy instance | 1 |
| Insurance contract or identification number | 169820 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $115,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 169820 |
| Policy instance | 2 |
| Insurance contract or identification number | 169820 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $11,294 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $116,093 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,969 | | Insurance broker organization code? | 3 | | Insurance broker name | QUINTESSENTIAL ADVISORS, INC. |
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| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 6810201 |
| Policy instance | 3 |
| Insurance contract or identification number | 6810201 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $7,344 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,344 | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE BENEFITS, LLC |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $3,032 | | Total amount of fees paid to insurance company | USD $364 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,005 | | Amount paid for insurance broker fees | 364 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | NFP CORPORATE SERVICES, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $5,149 | | Total amount of fees paid to insurance company | USD $111 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $20,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,840 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 111 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | USI INSURANCE SERVICES, LLC |
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| DENTAL CARE PLUS, INC. (National Association of Insurance Commissioners NAIC id number: 96265 ) |
| Policy contract number | 6810201/6810801 |
| Policy instance | 2 |
| Insurance contract or identification number | 6810201/6810801 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,211 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,211 | | Insurance broker organization code? | 3 | | Insurance broker name | QUINTESSENTIAL ADVISORS |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 548 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $17,229 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $224,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,135 | | Insurance broker organization code? | 3 | | Insurance broker name | NFP CORPORATE SERVICES, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 533 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $15,864 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $245,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05731701 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05731701 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $7,925 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $89,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 ) |
| Policy contract number | 00169820 |
| Policy instance | 1 |
| Insurance contract or identification number | 00169820 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $16,933 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $199,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10029245 00000 |
| Policy instance | 3 |
| Insurance contract or identification number | 10029245 00000 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $390 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
