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NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameNORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN
Plan identification number 501

NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

NORTHEAST ARKANSAS HEALTH & WELFARE TRUST has sponsored the creation of one or more 401k plans.

Company Name:NORTHEAST ARKANSAS HEALTH & WELFARE TRUST
Employer identification number (EIN):466683289
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01SHELLEY GARRETT2023-09-25
5012021-04-01SHELLEY GARRETT2022-08-08
5012020-04-01SHELLEY GARRETT2021-09-16
5012019-04-01SHELLEY GARRETT2020-07-17
5012018-04-01SHELLEY GARRETT2019-10-24
5012017-04-01
5012017-04-01SHELLEY GARRETT2019-10-24
5012016-04-01STEVE BRYANT2018-11-16
5012016-04-01SHELLEY GARRETT2019-10-24
5012015-04-01STEVE BRYANT2018-11-16
5012015-04-01SHELLEY GARRETT2019-10-24
5012014-04-01SHELLEY GARRETT2019-10-24
5012014-04-01STEVE BRYANT2018-11-16
5012013-04-01STEVE BRYANT

Plan Statistics for NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN

Measure Date Value
2022: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-0162
Total number of active participants reported on line 7a of the Form 55002022-04-0164
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-0164
Number of employers contributing to the scheme2022-04-010
2021: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-0173
Total number of active participants reported on line 7a of the Form 55002021-04-0164
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-0164
Number of employers contributing to the scheme2021-04-010
2020: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-0169
Total number of active participants reported on line 7a of the Form 55002020-04-0172
Number of retired or separated participants receiving benefits2020-04-011
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-0173
Number of employers contributing to the scheme2020-04-010
2019: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-0168
Total number of active participants reported on line 7a of the Form 55002019-04-0170
Number of retired or separated participants receiving benefits2019-04-011
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-0171
Number of employers contributing to the scheme2019-04-010
2018: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-0169
Total number of active participants reported on line 7a of the Form 55002018-04-0167
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-0167
Number of employers contributing to the scheme2018-04-010
2017: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-0158
Total number of active participants reported on line 7a of the Form 55002017-04-0169
Number of retired or separated participants receiving benefits2017-04-011
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-0170
Number of employers contributing to the scheme2017-04-010
2016: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-0158
Total number of active participants reported on line 7a of the Form 55002016-04-0165
Number of retired or separated participants receiving benefits2016-04-012
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-0167
Number of employers contributing to the scheme2016-04-010
2015: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-0171
Total number of active participants reported on line 7a of the Form 55002015-04-0164
Number of retired or separated participants receiving benefits2015-04-012
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-0166
Number of employers contributing to the scheme2015-04-010
2014: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-0178
Total number of active participants reported on line 7a of the Form 55002014-04-0171
Number of retired or separated participants receiving benefits2014-04-010
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-0171
Number of employers contributing to the scheme2014-04-010
2013: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-0176
Total number of active participants reported on line 7a of the Form 55002013-04-0173
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-0173

Financial Data on NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN

Measure Date Value
2023 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2023 401k financial data
Total income from all sources2023-03-31$587,811
Expenses. Total of all expenses incurred2023-03-31$775,135
Benefits paid (including direct rollovers)2023-03-31$566,524
Total plan assets at end of year2023-03-31$30,469
Total plan assets at beginning of year2023-03-31$217,793
Total contributions received or receivable from participants2023-03-31$97,156
Contributions received from other sources (not participants or employers)2023-03-31$1,582
Net income (gross income less expenses)2023-03-31$-187,324
Net plan assets at end of year (total assets less liabilities)2023-03-31$30,469
Net plan assets at beginning of year (total assets less liabilities)2023-03-31$217,793
Total contributions received or receivable from employer(s)2023-03-31$489,073
Expenses. Administrative service providers (salaries,fees and commissions)2023-03-31$208,611
2022 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2022 401k financial data
Total income from all sources2022-03-31$1,179,039
Expenses. Total of all expenses incurred2022-03-31$1,305,633
Benefits paid (including direct rollovers)2022-03-31$1,129,732
Total plan assets at end of year2022-03-31$217,793
Total plan assets at beginning of year2022-03-31$344,387
Total contributions received or receivable from participants2022-03-31$114,948
Contributions received from other sources (not participants or employers)2022-03-31$647,162
Net income (gross income less expenses)2022-03-31$-126,594
Net plan assets at end of year (total assets less liabilities)2022-03-31$217,793
Net plan assets at beginning of year (total assets less liabilities)2022-03-31$344,387
Total contributions received or receivable from employer(s)2022-03-31$416,929
Expenses. Administrative service providers (salaries,fees and commissions)2022-03-31$175,901
2021 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2021 401k financial data
Total income from all sources2021-03-31$641,796
Expenses. Total of all expenses incurred2021-03-31$629,935
Benefits paid (including direct rollovers)2021-03-31$431,662
Total plan assets at end of year2021-03-31$344,387
Total plan assets at beginning of year2021-03-31$332,526
Total contributions received or receivable from participants2021-03-31$130,324
Contributions received from other sources (not participants or employers)2021-03-31$7,333
Net income (gross income less expenses)2021-03-31$11,861
Net plan assets at end of year (total assets less liabilities)2021-03-31$344,387
Net plan assets at beginning of year (total assets less liabilities)2021-03-31$332,526
Total contributions received or receivable from employer(s)2021-03-31$504,139
Expenses. Administrative service providers (salaries,fees and commissions)2021-03-31$198,273
2020 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2020 401k financial data
Total income from all sources2020-03-31$630,860
Expenses. Total of all expenses incurred2020-03-31$640,841
Benefits paid (including direct rollovers)2020-03-31$467,962
Total plan assets at end of year2020-03-31$332,526
Total plan assets at beginning of year2020-03-31$342,507
Total contributions received or receivable from participants2020-03-31$131,560
Contributions received from other sources (not participants or employers)2020-03-31$20,442
Other income received2020-03-31$0
Noncash contributions received2020-03-31$0
Net income (gross income less expenses)2020-03-31$-9,981
Net plan assets at end of year (total assets less liabilities)2020-03-31$332,526
Net plan assets at beginning of year (total assets less liabilities)2020-03-31$342,507
Total contributions received or receivable from employer(s)2020-03-31$478,858
Value of certain deemed distributions of participant loans2020-03-31$0
Value of corrective distributions2020-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-03-31$172,879
2019 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2019 401k financial data
Transfers to/from the plan2019-03-31$0
Total plan liabilities at end of year2019-03-31$0
Total plan liabilities at beginning of year2019-03-31$0
Total income from all sources2019-03-31$626,351
Expenses. Total of all expenses incurred2019-03-31$594,590
Benefits paid (including direct rollovers)2019-03-31$417,822
Total plan assets at end of year2019-03-31$342,507
Total plan assets at beginning of year2019-03-31$310,746
Total contributions received or receivable from participants2019-03-31$161,534
Expenses. Other expenses not covered elsewhere2019-03-31$0
Contributions received from other sources (not participants or employers)2019-03-31$24,066
Other income received2019-03-31$0
Noncash contributions received2019-03-31$0
Net income (gross income less expenses)2019-03-31$31,761
Net plan assets at end of year (total assets less liabilities)2019-03-31$342,507
Net plan assets at beginning of year (total assets less liabilities)2019-03-31$310,746
Total contributions received or receivable from employer(s)2019-03-31$440,751
Value of certain deemed distributions of participant loans2019-03-31$0
Value of corrective distributions2019-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-03-31$176,768
2018 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2018 401k financial data
Total income from all sources2018-03-31$692,907
Expenses. Total of all expenses incurred2018-03-31$564,108
Benefits paid (including direct rollovers)2018-03-31$396,521
Total plan assets at end of year2018-03-31$310,746
Total plan assets at beginning of year2018-03-31$181,947
Total contributions received or receivable from participants2018-03-31$141,681
Contributions received from other sources (not participants or employers)2018-03-31$14,751
Net income (gross income less expenses)2018-03-31$128,799
Net plan assets at end of year (total assets less liabilities)2018-03-31$310,746
Net plan assets at beginning of year (total assets less liabilities)2018-03-31$181,947
Total contributions received or receivable from employer(s)2018-03-31$536,475
Expenses. Administrative service providers (salaries,fees and commissions)2018-03-31$167,587
2017 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2017 401k financial data
Total income from all sources2017-03-31$940,054
Expenses. Total of all expenses incurred2017-03-31$987,348
Benefits paid (including direct rollovers)2017-03-31$832,388
Total plan assets at end of year2017-03-31$181,947
Total plan assets at beginning of year2017-03-31$229,241
Total contributions received or receivable from participants2017-03-31$98,570
Contributions received from other sources (not participants or employers)2017-03-31$242,384
Net income (gross income less expenses)2017-03-31$-47,294
Net plan assets at end of year (total assets less liabilities)2017-03-31$181,947
Net plan assets at beginning of year (total assets less liabilities)2017-03-31$229,241
Total contributions received or receivable from employer(s)2017-03-31$599,100
Expenses. Administrative service providers (salaries,fees and commissions)2017-03-31$154,960
2016 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2016 401k financial data
Total income from all sources2016-03-31$619,177
Expenses. Total of all expenses incurred2016-03-31$556,529
Benefits paid (including direct rollovers)2016-03-31$403,410
Total plan assets at end of year2016-03-31$229,241
Total plan assets at beginning of year2016-03-31$166,593
Total contributions received or receivable from participants2016-03-31$95,418
Contributions received from other sources (not participants or employers)2016-03-31$91,563
Net income (gross income less expenses)2016-03-31$62,648
Net plan assets at end of year (total assets less liabilities)2016-03-31$229,241
Net plan assets at beginning of year (total assets less liabilities)2016-03-31$166,593
Total contributions received or receivable from employer(s)2016-03-31$432,196
Expenses. Administrative service providers (salaries,fees and commissions)2016-03-31$153,119
2015 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2015 401k financial data
Transfers to/from the plan2015-03-31$0
Total plan liabilities at end of year2015-03-31$166,593
Total plan liabilities at beginning of year2015-03-31$116,989
Total income from all sources2015-03-31$604,718
Expenses. Total of all expenses incurred2015-03-31$555,114
Benefits paid (including direct rollovers)2015-03-31$391,631
Total plan assets at end of year2015-03-31$166,593
Total plan assets at beginning of year2015-03-31$116,989
Total contributions received or receivable from participants2015-03-31$126,810
Expenses. Other expenses not covered elsewhere2015-03-31$0
Contributions received from other sources (not participants or employers)2015-03-31$17,759
Other income received2015-03-31$0
Noncash contributions received2015-03-31$0
Net income (gross income less expenses)2015-03-31$49,604
Net plan assets at end of year (total assets less liabilities)2015-03-31$166,593
Net plan assets at beginning of year (total assets less liabilities)2015-03-31$116,989
Total contributions received or receivable from employer(s)2015-03-31$460,149
Value of certain deemed distributions of participant loans2015-03-31$0
Value of corrective distributions2015-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-03-31$163,483
2014 : NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2014 401k financial data
Transfers to/from the plan2014-03-31$0
Total plan liabilities at end of year2014-03-31$0
Total plan liabilities at beginning of year2014-03-31$0
Total income from all sources2014-03-31$648,076
Expenses. Total of all expenses incurred2014-03-31$531,087
Benefits paid (including direct rollovers)2014-03-31$345,614
Total plan assets at end of year2014-03-31$116,989
Total plan assets at beginning of year2014-03-31$0
Total contributions received or receivable from participants2014-03-31$191,865
Expenses. Other expenses not covered elsewhere2014-03-31$0
Contributions received from other sources (not participants or employers)2014-03-31$0
Other income received2014-03-31$0
Noncash contributions received2014-03-31$0
Net income (gross income less expenses)2014-03-31$116,989
Net plan assets at end of year (total assets less liabilities)2014-03-31$116,989
Net plan assets at beginning of year (total assets less liabilities)2014-03-31$0
Total contributions received or receivable from employer(s)2014-03-31$456,211
Value of certain deemed distributions of participant loans2014-03-31$0
Value of corrective distributions2014-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-03-31$185,473

Form 5500 Responses for NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN

2022: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – TrustYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement - TrustYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – TrustYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement - TrustYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement - TrustYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement - TrustYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement - TrustYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement - TrustYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement - TrustYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – TrustYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement - TrustYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedYes
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – TrustYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement - TrustYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: NORTHEAST ARKANSAS EMPLOYEE HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01First time form 5500 has been submittedYes
2013-04-01Submission has been amendedYes
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – TrustYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement - TrustYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1103-2019R5
Policy instance 1
Insurance contract or identification numberS1103-2019R5
Number of Individuals Covered64
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $11,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
WESTERN SKIES MGU LLC (National Association of Insurance Commissioners NAIC id number: 99999 )
Policy contract number00
Policy instance 2
Insurance contract or identification number00
Number of Individuals Covered64
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $157,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1103-2019R5
Policy instance 1
Insurance contract or identification numberS1103-2019R5
Number of Individuals Covered64
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $149,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1103-2019R5
Policy instance 1
Insurance contract or identification numberS1103-2019R5
Number of Individuals Covered72
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $142,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1085-2018R4
Policy instance 1
Insurance contract or identification numberS1085-2018R4
Number of Individuals Covered67
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $134,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1085-2018R4
Policy instance 1
Insurance contract or identification numberS1085-2018R4
Number of Individuals Covered66
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $127,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
EXCESS RE (National Association of Insurance Commissioners NAIC id number: 38776 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered68
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $20,094
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 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 $138,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees20094
Additional information about fees paid to insurance brokerBENEFIT ADMINISTRATION
Insurance broker organization code?3
Insurance broker nameCORPORATE BENEFITS SERVICE
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberS1070-2017R3
Policy instance 1
Insurance contract or identification numberS1070-2017R3
Number of Individuals Covered63
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $138,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201707
Policy instance 1
Insurance contract or identification numberUNI-201707
Number of Individuals Covered66
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $169,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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