MEMORIAL HEALTH CARE SYSTEMS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN
401k plan membership statisitcs for MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN
| Measure | Date | Value |
|---|
| 2019: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 0 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 156 |
| Total of all active and inactive participants | 2018-01-01 | 156 |
| 2017: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 154 |
| Total of all active and inactive participants | 2017-01-01 | 154 |
| 2016: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 155 |
| Total of all active and inactive participants | 2016-01-01 | 155 |
| 2015: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 147 |
| Total of all active and inactive participants | 2015-01-01 | 147 |
| 2014: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 147 |
| Total of all active and inactive participants | 2014-01-01 | 147 |
| 2013: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 147 |
| Total of all active and inactive participants | 2013-01-01 | 147 |
| 2012: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 225 |
| Total of all active and inactive participants | 2012-01-01 | 225 |
| 2011: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 152 |
| Total of all active and inactive participants | 2011-01-01 | 152 |
| 2010: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-06-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 151 |
| Total of all active and inactive participants | 2010-06-01 | 151 |
| 2009: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 83 |
| Total of all active and inactive participants | 2009-06-01 | 83 |
| 2019: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2010 form 5500 responses |
|---|
| 2010-06-01 | Type of plan entity | Single employer plan |
| 2010-06-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2010-06-01 | Plan funding arrangement – Insurance | Yes |
| 2010-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MEMORIAL HEALTH CARE SYSTEMS LIFE, AD&D, DISABILITY, DENTAL AND VISION PLAN 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 165077 |
| Policy instance | 2 |
| Insurance contract or identification number | 165077 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $11,275 | | Total amount of fees paid to insurance company | USD $3,711 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,275 | | Amount paid for insurance broker fees | 3711 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-049164 |
| Policy instance | 1 |
| Insurance contract or identification number | 010-049164 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $10,163 | | Total amount of fees paid to insurance company | USD $510 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,163 | | Amount paid for insurance broker fees | 510 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1048104 |
| Policy instance | 1 |
| Insurance contract or identification number | 1048104 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $19,202 | | Total amount of fees paid to insurance company | USD $1,877 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $269,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,954 | | Amount paid for insurance broker fees | 1877 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1048104 |
| Policy instance | 1 |
| Insurance contract or identification number | 1048104 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $17,957 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $250,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,957 | | Insurance broker organization code? | 3 | | Insurance broker name | SHANE M BAACK |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1048104 |
| Policy instance | 1 |
| Insurance contract or identification number | 1048104 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $9,971 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $169,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,230 | | Insurance broker organization code? | 3 | | Insurance broker name | SHANE M BAACK |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H03084 |
| Policy instance | 1 |
| Insurance contract or identification number | H03084 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,465 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,022 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H68140 |
| Policy instance | 2 |
| Insurance contract or identification number | H68140 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,370 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,650 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-039346 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-039346 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,986 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,986 | | Insurance broker organization code? | 3 | | Insurance broker name | KOLTERMAN AGENCY INC. |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-039346 |
| Policy instance | 3 |
| Insurance contract or identification number | 010-039346 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,794 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,923 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,794 | | Insurance broker organization code? | 3 | | Insurance broker name | KOLTERMAN AGENCY INC. |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H68140 |
| Policy instance | 2 |
| Insurance contract or identification number | H68140 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $5,247 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,555 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H03084 |
| Policy instance | 1 |
| Insurance contract or identification number | H03084 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,355 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $951 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H68140 |
| Policy instance | 2 |
| Insurance contract or identification number | H68140 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,273 | | Total amount of fees paid to insurance company | USD $300 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,575 | | Amount paid for insurance broker fees | 300 | | Additional information about fees paid to insurance broker | AGENT EXPENSE ALLOWANCE | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H03084 |
| Policy instance | 1 |
| Insurance contract or identification number | H03084 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,070 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,571 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H68140 |
| Policy instance | 2 |
| Insurance contract or identification number | H68140 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,969 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H03084 |
| Policy instance | 1 |
| Insurance contract or identification number | H03084 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,318 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H68140 |
| Policy instance | 2 |
| Insurance contract or identification number | H68140 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,223 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,699 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | H03084 |
| Policy instance | 1 |
| Insurance contract or identification number | H03084 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,435 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,208 | | Insurance broker organization code? | 3 | | Insurance broker name | ROGERS BENEFIT GROUP, INC |
|
