LONE STAR CIRCLE OF CARE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LONE STAR CIRCLE OF CARE HEALTHCARE PLAN
| Measure | Date | Value |
|---|
| 2021: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 683 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 648 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 7 |
| Total of all active and inactive participants | 2021-10-01 | 667 |
| 2020: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 650 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 555 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 27 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
| Total of all active and inactive participants | 2020-10-01 | 582 |
| 2019: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 576 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 603 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 4 |
| Total of all active and inactive participants | 2019-10-01 | 611 |
| 2018: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 504 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 570 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 572 |
| 2017: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 396 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 436 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 436 |
| 2016: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 420 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 412 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 420 |
| 2015: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 414 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 372 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 17 |
| Total of all active and inactive participants | 2015-10-01 | 391 |
| 2014: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 397 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 325 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 14 |
| Total of all active and inactive participants | 2014-10-01 | 340 |
| 2013: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 550 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 394 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 19 |
| Total of all active and inactive participants | 2013-10-01 | 420 |
| 2012: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 522 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 530 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 36 |
| Total of all active and inactive participants | 2012-10-01 | 573 |
| 2011: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 466 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 522 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 24 |
| Total of all active and inactive participants | 2011-10-01 | 553 |
| 2010: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 452 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 30 |
| Total of all active and inactive participants | 2010-10-01 | 487 |
| 2009: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 269 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 378 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 75 |
| Total of all active and inactive participants | 2009-10-01 | 458 |
| Total participants | 2009-10-01 | 0 |
| 2008: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-10-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 262 |
| Number of retired or separated participants receiving benefits | 2008-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2008-10-01 | 39 |
| Total of all active and inactive participants | 2008-10-01 | 302 |
| Total participants | 2008-10-01 | 0 |
| 2007: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-10-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-10-01 | 160 |
| Number of retired or separated participants receiving benefits | 2007-10-01 | 8 |
| Number of other retired or separated participants entitled to future benefits | 2007-10-01 | 38 |
| Total of all active and inactive participants | 2007-10-01 | 206 |
| Total participants | 2007-10-01 | 0 |
| 2021: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Submission has been amended | No |
| 2018-10-01 | This submission is the final filing | No |
| 2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-10-01 | Plan is a collectively bargained plan | No |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | Yes |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | Submission has been amended | No |
| 2010-10-01 | This submission is the final filing | No |
| 2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-10-01 | Plan is a collectively bargained plan | No |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| 2008-10-01 | Plan funding arrangement – Insurance | Yes |
| 2008-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: LONE STAR CIRCLE OF CARE HEALTHCARE PLAN 2007 form 5500 responses |
|---|
| 2007-10-01 | Type of plan entity | Single employer plan |
| 2007-10-01 | First time form 5500 has been submitted | Yes |
| 2007-10-01 | Submission has been amended | No |
| 2007-10-01 | This submission is the final filing | No |
| 2007-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-10-01 | Plan is a collectively bargained plan | No |
| 2007-10-01 | Plan funding arrangement – Insurance | Yes |
| 2007-10-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401G |
| Policy instance | 4 |
| Insurance contract or identification number | 768401G | | Number of Individuals Covered | 632 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $16,466 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $445,170 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9031 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0000157808 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000157808 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $156 | | Total amount of fees paid to insurance company | USD $5 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $89 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0000153639 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000153639 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $4,179 | | Total amount of fees paid to insurance company | USD $364 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,684 | | Amount paid for insurance broker fees | 364 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00516312 |
| Policy instance | 1 |
| Insurance contract or identification number | 00516312 | | Number of Individuals Covered | 583 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,461 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2461 | | Additional information about fees paid to insurance broker | TOTAL FEES PAID | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00516312 |
| Policy instance | 1 |
| Insurance contract or identification number | 00516312 | | Number of Individuals Covered | 584 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,076 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1076 | | Additional information about fees paid to insurance broker | TOTAL FEES PAID | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0000153639 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000153639 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $5,747 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,826 | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 0000157808 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000157808 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $164 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401G |
| Policy instance | 4 |
| Insurance contract or identification number | 768401G | | Number of Individuals Covered | 639 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $9,936 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $426,777 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9936 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 460569G-VCI |
| Policy instance | 2 |
| Insurance contract or identification number | 460569G-VCI | | Number of Individuals Covered | 170 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $326 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $42,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 326 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 153639 |
| Policy instance | 3 |
| Insurance contract or identification number | 153639 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $5,391 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $55,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,544 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00516312 |
| Policy instance | 4 |
| Insurance contract or identification number | 00516312 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $557 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 557 | | Additional information about fees paid to insurance broker | TOTAL FEES PAID | | Insurance broker organization code? | 3 |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 157808 |
| Policy instance | 5 |
| Insurance contract or identification number | 157808 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $148 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $2,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 764801-GLT |
| Policy instance | 6 |
| Insurance contract or identification number | 764801-GLT | | Number of Individuals Covered | 658 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,907 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $231,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1907 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401-GRH |
| Policy instance | 7 |
| Insurance contract or identification number | 768401-GRH | | Number of Individuals Covered | 619 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,157 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $133,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1157 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401-0GL |
| Policy instance | 8 |
| Insurance contract or identification number | 768401-0GL | | Number of Individuals Covered | 618 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,229 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $137,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1229 | | Additional information about fees paid to insurance broker | BONUS PAID | | 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 | 460570-VAC |
| Policy instance | 1 |
| Insurance contract or identification number | 460570-VAC | | Number of Individuals Covered | 210 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $296 | | Other welfare benefits provided | ACCIDENT - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $40,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 296 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 157808 |
| Policy instance | 8 |
| Insurance contract or identification number | 157808 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $158 | | Total amount of fees paid to insurance company | USD $13 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $85 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 13 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401-0GL |
| Policy instance | 7 |
| Insurance contract or identification number | 768401-0GL | | Number of Individuals Covered | 583 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,402 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $113,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3402 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00516312 |
| Policy instance | 2 |
| Insurance contract or identification number | 00516312 | | Number of Individuals Covered | 538 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,327 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2327 | | Additional information about fees paid to insurance broker | TOTAL FEES PAID | | 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 | 764801-GLT |
| Policy instance | 1 |
| Insurance contract or identification number | 764801-GLT | | Number of Individuals Covered | 583 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $4,510 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $168,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4510 | | Additional information about fees paid to insurance broker | BONUS PAID | | 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 | 768401-GRH |
| Policy instance | 3 |
| Insurance contract or identification number | 768401-GRH | | Number of Individuals Covered | 584 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,071 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $108,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 2071 | | Additional information about fees paid to insurance broker | BONUS PAID | | 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 | 460569G-VCI |
| Policy instance | 4 |
| Insurance contract or identification number | 460569G-VCI | | Number of Individuals Covered | 163 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $512 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $26,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 512 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 153639 |
| Policy instance | 5 |
| Insurance contract or identification number | 153639 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $5,918 | | Total amount of fees paid to insurance company | USD $293 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $52,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,847 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 293 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 460570-VAC |
| Policy instance | 6 |
| Insurance contract or identification number | 460570-VAC | | Number of Individuals Covered | 211 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $483 | | Other welfare benefits provided | ACCIDENT - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $23,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 483 | | Additional information about fees paid to insurance broker | BONUS PAID | | 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 | 764801-GLT |
| Policy instance | 2 |
| Insurance contract or identification number | 764801-GLT | | Number of Individuals Covered | 472 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $9,380 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 210847 |
| Policy instance | 3 |
| Insurance contract or identification number | 210847 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-04-01 | | Total amount of commissions paid to insurance broker | USD $456 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LONG TERM CARE | | Welfare Benefit Premiums Paid to Carrier | USD $2,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00516312 |
| Policy instance | 4 |
| Insurance contract or identification number | 00516312 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $9,660 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 460569G-VCI |
| Policy instance | 5 |
| Insurance contract or identification number | 460569G-VCI | | Number of Individuals Covered | 86 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,066 | | Other welfare benefits provided | CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $19,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 157808 |
| Policy instance | 6 |
| Insurance contract or identification number | 157808 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $159 | | Total amount of fees paid to insurance company | USD $22 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $1,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401-GRH |
| Policy instance | 7 |
| Insurance contract or identification number | 768401-GRH | | Number of Individuals Covered | 472 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6,483 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,038 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 768401-0GL |
| Policy instance | 8 |
| Insurance contract or identification number | 768401-0GL | | Number of Individuals Covered | 472 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6,723 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | A D & D | | Welfare Benefit Premiums Paid to Carrier | USD $90,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 460570-VAC |
| Policy instance | 9 |
| Insurance contract or identification number | 460570-VAC | | Number of Individuals Covered | 120 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,073 | | Other welfare benefits provided | ACCIDENT - VOLUNTARY | | Welfare Benefit Premiums Paid to Carrier | USD $19,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 153639 |
| Policy instance | 1 |
| Insurance contract or identification number | 153639 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $6,578 | | Total amount of fees paid to insurance company | USD $983 | | Other welfare benefits provided | DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $59,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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