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HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 401k Plan overview

Plan NameHEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY
Plan identification number 501

HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

BENEVOLENT CORPORATION CEDAR COMMUNITY has sponsored the creation of one or more 401k plans.

Company Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Employer identification number (EIN):390928211
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012020-07-01TRACY BLAUBACH2021-04-13
5012019-07-01TRACY BLAUBACH2021-01-19
5012019-07-01TRACY BLAUBACH2021-04-13
5012018-07-01CHARLOTTE FREEMAN2020-03-27
5012017-07-01JOSEPH PICHLER KEVIN SANDER2019-01-31
5012016-07-01CHRISTOPHER CHERNEY KEVIN SANDER2018-03-29
5012015-07-01CHRISTOPHER CHERNEY
5012014-07-01LYDIA WEBER-FRITSCHE SAM HOLIDAY2015-12-28
5012013-07-01SAM HOLIDAY CHRISTOPHER CHERNEY2015-01-28
5012012-07-01SUE BECKER CHRISTOPHER CHERNEY2014-03-25
5012011-07-01SUE BECKER CHRISTOPHER CHERNEY2013-01-31
5012010-07-01SUE BECKER CHRISTOPHER CHERNEY2012-01-24
5012009-07-01SUE BECKER CHRISTOPHER CHERNEY2011-01-17

Plan Statistics for HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY

401k plan membership statisitcs for HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY

Measure Date Value
2020: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2020 401k membership
Total participants, beginning-of-year2020-07-01217
Total number of active participants reported on line 7a of the Form 55002020-07-010
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-010
2019: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2019 401k membership
Total participants, beginning-of-year2019-07-01233
Total number of active participants reported on line 7a of the Form 55002019-07-010
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-010
2018: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2018 401k membership
Total participants, beginning-of-year2018-07-01246
Total number of active participants reported on line 7a of the Form 55002018-07-01230
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01230
Number of employers contributing to the scheme2018-07-010
2017: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2017 401k membership
Total participants, beginning-of-year2017-07-01301
Total number of active participants reported on line 7a of the Form 55002017-07-01246
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01246
Total participants2017-07-01246
2016: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2016 401k membership
Total participants, beginning-of-year2016-07-01318
Total number of active participants reported on line 7a of the Form 55002016-07-01301
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-01301
2015: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2015 401k membership
Total participants, beginning-of-year2015-07-01337
Total number of active participants reported on line 7a of the Form 55002015-07-01318
Total of all active and inactive participants2015-07-01318
Total participants2015-07-01318
2014: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2014 401k membership
Total participants, beginning-of-year2014-07-01406
Total number of active participants reported on line 7a of the Form 55002014-07-01337
Total of all active and inactive participants2014-07-01337
Total participants2014-07-01337
2013: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2013 401k membership
Total participants, beginning-of-year2013-07-01429
Total number of active participants reported on line 7a of the Form 55002013-07-01406
Total of all active and inactive participants2013-07-01406
Total participants2013-07-01406
2012: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2012 401k membership
Total participants, beginning-of-year2012-07-01436
Total number of active participants reported on line 7a of the Form 55002012-07-01429
Total of all active and inactive participants2012-07-01429
Total participants2012-07-01429
2011: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2011 401k membership
Total participants, beginning-of-year2011-07-01431
Total number of active participants reported on line 7a of the Form 55002011-07-01436
Total of all active and inactive participants2011-07-01436
Total participants2011-07-01436
2010: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2010 401k membership
Total participants, beginning-of-year2010-07-01423
Total number of active participants reported on line 7a of the Form 55002010-07-01431
Total of all active and inactive participants2010-07-01431
Total participants2010-07-01431
2009: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2009 401k membership
Total participants, beginning-of-year2009-07-01429
Total number of active participants reported on line 7a of the Form 55002009-07-01423
Total of all active and inactive participants2009-07-01423
Total participants2009-07-01423

Form 5500 Responses for HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY

2020: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingYes
2020-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingYes
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedYes
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2010: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – General assets of the sponsorYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: HEALTH PROTECTION PLAN - BENEVOLENT CORPORATION CEDAR COMMUNITY 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number940590
Policy instance 1
Insurance contract or identification number940590
Number of Individuals Covered204
Insurance policy start date2020-07-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $159,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered343
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $10,580
Total amount of fees paid to insurance companyUSD $33,792
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $33,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees21153
Additional information about fees paid to insurance brokerADMINISTRATION FEE
Insurance broker organization code?3
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberUS200747
Policy instance 1
Insurance contract or identification numberUS200747
Number of Individuals Covered318
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedINSURED TRANSPLANT
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 CarrierUSD $36,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number417007410423
Policy instance 1
Insurance contract or identification number417007410423
Number of Individuals Covered337
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $452,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract number417006410423
Policy instance 2
Insurance contract or identification number417006410423
Number of Individuals Covered337
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedINSURED TRANSPLANT
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 CarrierUSD $43,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number417005410423
Policy instance 1
Insurance contract or identification number417005410423
Number of Individuals Covered406
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $506,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number417005410423
Policy instance 1
Insurance contract or identification number417005410423
Number of Individuals Covered429
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $39,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number417005410423
Policy instance 1
Insurance contract or identification number417005410423
Number of Individuals Covered436
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $376,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number417003410423
Policy instance 2
Insurance contract or identification number417003410423
Number of Individuals Covered431
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedINSURED TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $31,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number417002410423
Policy instance 1
Insurance contract or identification number417002410423
Number of Individuals Covered431
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Health Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $345,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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