VALLEY TELEPHONE COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY
401k plan membership statisitcs for VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY
| Measure | Date | Value |
|---|
| 2022: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 33 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 33 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 38 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 38 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 36 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 36 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 34 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 1 |
| 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 | 35 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 39 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 39 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 26 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 28 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 28 |
| 2016: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 15 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 16 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 16 |
| 2010: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 176 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 23 |
| Total of all active and inactive participants | 2010-01-01 | 199 |
| Total participants | 2010-01-01 | 199 |
| 2009: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 151 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 22 |
| Total of all active and inactive participants | 2009-01-01 | 173 |
| Total participants | 2009-01-01 | 173 |
| Measure | Date | Value |
|---|
| 2022 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $-963,578 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $143,300 |
| Total plan assets at end of year | 2022-12-31 | $15,645,386 |
| Total plan assets at beginning of year | 2022-12-31 | $16,752,264 |
| Value of fidelity bond covering the plan | 2022-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $84,051 |
| Other income received | 2022-12-31 | $-1,047,629 |
| Net income (gross income less expenses) | 2022-12-31 | $-1,106,878 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $15,645,386 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $16,752,264 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $143,300 |
| 2021 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $2,031,683 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $139,919 |
| Total plan assets at end of year | 2021-12-31 | $16,752,264 |
| Total plan assets at beginning of year | 2021-12-31 | $14,860,500 |
| Value of fidelity bond covering the plan | 2021-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $87,405 |
| Other income received | 2021-12-31 | $1,944,278 |
| Net income (gross income less expenses) | 2021-12-31 | $1,891,764 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $16,752,264 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $14,860,500 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $139,919 |
| 2020 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $-17,815 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $124,135 |
| Total plan assets at end of year | 2020-12-31 | $14,860,500 |
| Total plan assets at beginning of year | 2020-12-31 | $15,002,450 |
| Value of fidelity bond covering the plan | 2020-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $53,939 |
| Other income received | 2020-12-31 | $-71,754 |
| Net income (gross income less expenses) | 2020-12-31 | $-141,950 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $14,860,500 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $15,002,450 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $124,135 |
| 2019 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $2,741,927 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $120,363 |
| Total plan assets at end of year | 2019-12-31 | $15,002,450 |
| Total plan assets at beginning of year | 2019-12-31 | $12,380,886 |
| Value of fidelity bond covering the plan | 2019-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $101,850 |
| Other income received | 2019-12-31 | $2,640,077 |
| Net income (gross income less expenses) | 2019-12-31 | $2,621,564 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $15,002,450 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $12,380,886 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $120,363 |
| 2018 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2018 401k financial data |
|---|
| Transfers to/from the plan | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $434,720 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,375,879 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $0 |
| Total plan assets at end of year | 2018-12-31 | $12,380,886 |
| Total plan assets at beginning of year | 2018-12-31 | $13,322,045 |
| Value of fidelity bond covering the plan | 2018-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $1,298,596 |
| Net income (gross income less expenses) | 2018-12-31 | $-941,159 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $12,380,886 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $13,322,045 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $434,720 |
| Value of certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of corrective distributions | 2018-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $77,283 |
| 2017 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $2,259,475 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $110,496 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $390,155 |
| Total plan assets at end of year | 2017-12-31 | $13,322,045 |
| Total plan assets at beginning of year | 2017-12-31 | $11,173,066 |
| Value of fidelity bond covering the plan | 2017-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $110,496 |
| Other income received | 2017-12-31 | $1,430,190 |
| Net income (gross income less expenses) | 2017-12-31 | $2,148,979 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $13,322,045 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $11,173,066 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $829,285 |
| 2016 : VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $869,826 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $8,589 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $291,892 |
| Total plan assets at end of year | 2016-12-31 | $11,173,066 |
| Total plan assets at beginning of year | 2016-12-31 | $10,311,829 |
| Value of fidelity bond covering the plan | 2016-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $8,589 |
| Other income received | 2016-12-31 | $869,826 |
| Net income (gross income less expenses) | 2016-12-31 | $861,237 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $11,173,066 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $10,311,829 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $0 |
| 2022: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 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 funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: VALLEY TELEPHONE POSTRETIREMENT BENEFIT POLICY 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | NIS164601 |
| Policy instance | 4 |
| Insurance contract or identification number | NIS164601 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $78,204 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $521,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $78,204 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40583 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40583 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,249 | | Total amount of fees paid to insurance company | USD $1,889 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $52,499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,249 | | Amount paid for insurance broker fees | 1889 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 52 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,000 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $130,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,000 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003139 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP-003139 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $26,578 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $177,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,578 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003139 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP-003139 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $26,912 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $179,412 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,912 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 51 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $4,944 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $126,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,944 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40583 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40583 | | Number of Individuals Covered | 249 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,281 | | Total amount of fees paid to insurance company | USD $1,897 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $52,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,281 | | Amount paid for insurance broker fees | 1897 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | NIS164601 |
| Policy instance | 4 |
| Insurance contract or identification number | NIS164601 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $72,049 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $480,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,049 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | NR309976 |
| Policy instance | 4 |
| Insurance contract or identification number | NR309976 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $73,954 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $493,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $73,954 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40583 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40583 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $5,187 | | Total amount of fees paid to insurance company | USD $1,866 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $51,872 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,187 | | Amount paid for insurance broker fees | 1866 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,272 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $108,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,272 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003733 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP-003733 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,603 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,603 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 ) |
| Policy contract number | ESL00075001 |
| Policy instance | 4 |
| Insurance contract or identification number | ESL00075001 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $65,492 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $436,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $65,492 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40583 |
| Policy instance | 3 |
| Insurance contract or identification number | HCCLOT40583 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,840 | | Total amount of fees paid to insurance company | USD $1,742 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $48,397 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,840 | | Amount paid for insurance broker fees | 1742 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 24 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,016 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $61,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,016 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003139 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP-003139 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $22,179 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $147,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,179 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003139 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP-003139 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $17,403 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116,021 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,403 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 40 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,848 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $90,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,848 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-6218 |
| Policy instance | 3 |
| Insurance contract or identification number | 947-6218 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,716 | | Total amount of fees paid to insurance company | USD $1,697 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $47,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,716 | | Amount paid for insurance broker fees | 1697 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 |
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| WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 ) |
| Policy contract number | ESL00075000 |
| Policy instance | 4 |
| Insurance contract or identification number | ESL00075000 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $63,129 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $420,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,129 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-4629 |
| Policy instance | 3 |
| Insurance contract or identification number | 947-4629 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $74,188 | | Total amount of fees paid to insurance company | USD $17,377 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | 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 Carrier | USD $508,636 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,974 | | Amount paid for insurance broker fees | 15860 | | Additional information about fees paid to insurance broker | FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GPA |
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| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | BXMA |
| Policy instance | 2 |
| Insurance contract or identification number | BXMA | | Number of Individuals Covered | 36 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,336 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $75,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,336 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP ADMINISTRATIVE CONCEPTS |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP003139 |
| Policy instance | 1 |
| Insurance contract or identification number | AGP003139 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,231 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $52,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,231 | | Insurance broker organization code? | 3 | | Insurance broker name | TAGCO ASSOCIATES LP |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-8153 |
| Policy instance | 1 |
| Insurance contract or identification number | 280-8153 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,959 | | Other welfare benefits provided | TRANSPLANT | | Welfare Benefit Premiums Paid to Carrier | USD $29,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,959 | | Insurance broker organization code? | 3 | | Insurance broker name | GPA |
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