KENNEBEC BEHAVIORAL HEALTH has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN
| Measure | Date | Value |
|---|
| 2022: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 263 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 263 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 263 |
| 2021: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 245 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 243 |
| Number of retired or separated participants receiving benefits | 2021-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
| Total of all active and inactive participants | 2021-02-01 | 243 |
| 2020: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 245 |
| Number of retired or separated participants receiving benefits | 2020-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 245 |
| 2019: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 256 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 251 |
| Number of retired or separated participants receiving benefits | 2019-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
| Total of all active and inactive participants | 2019-02-01 | 251 |
| 2018: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 256 |
| Total of all active and inactive participants | 2018-02-01 | 256 |
| 2017: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 242 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 272 |
| Total of all active and inactive participants | 2017-02-01 | 272 |
| 2016: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 242 |
| Total of all active and inactive participants | 2016-02-01 | 242 |
| 2015: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 221 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 225 |
| Total of all active and inactive participants | 2015-02-01 | 225 |
| 2014: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 221 |
| Total of all active and inactive participants | 2014-02-01 | 221 |
| 2013: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 205 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 214 |
| Total of all active and inactive participants | 2013-02-01 | 214 |
| 2012: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 205 |
| Total of all active and inactive participants | 2012-02-01 | 205 |
| 2011: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 191 |
| Total of all active and inactive participants | 2011-02-01 | 191 |
| 2010: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 200 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 186 |
| Total of all active and inactive participants | 2010-02-01 | 186 |
| 2009: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-02-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 200 |
| Total of all active and inactive participants | 2009-02-01 | 200 |
| 2022: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Single employer plan |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: KENNEBEC BEHAVIORAL HEALTH MEDICAL PLAN 2009 form 5500 responses |
|---|
| 2009-02-01 | Type of plan entity | Single employer plan |
| 2009-02-01 | This submission is the final filing | No |
| 2009-02-01 | Plan funding arrangement – Insurance | Yes |
| 2009-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 ) |
| Policy contract number | 000963321 |
| Policy instance | 2 |
| Insurance contract or identification number | 000963321 | | Number of Individuals Covered | 476 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $2,200 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,913 | | Additional information about fees paid to insurance broker | NOT SPECIFIED | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202735 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202735 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $148,469 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $989,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $148,469 | | Insurance broker organization code? | 3 |
|
| RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 ) |
| Policy contract number | 000963321 |
| Policy instance | 2 |
| Insurance contract or identification number | 000963321 | | Number of Individuals Covered | 439 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $1,942 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,689 | | Additional information about fees paid to insurance broker | NOT SPECIFIED | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202735 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202735 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $132,930 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $886,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $132,930 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 508 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $1,679 | | Total amount of fees paid to insurance company | USD $86 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,679 | | Amount paid for insurance broker fees | 86 | | Additional information about fees paid to insurance broker | NOT SPECIFIED | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202735 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202735 | | Number of Individuals Covered | 245 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $135,675 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $904,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $135,675 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202735 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202735 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $132,823 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $885,489 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $132,823 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 440 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,488 | | Total amount of fees paid to insurance company | USD $41 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,882 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,488 | | Amount paid for insurance broker fees | 41 | | Additional information about fees paid to insurance broker | NOT SPECIFIED | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 457 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $1,444 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,444 | | Insurance broker organization code? | 3 |
|
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-202735 |
| Policy instance | 1 |
| Insurance contract or identification number | UNI-202735 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $131,609 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $877,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $131,609 | | Insurance broker organization code? | 3 |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $1,236 | | Total amount of fees paid to insurance company | USD $33 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,236 | | Amount paid for insurance broker fees | 33 | | Additional information about fees paid to insurance broker | NOT SPECIFIED ON SCHEDULE A | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19473 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19473 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $124,045 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $826,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $124,045 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES, INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 312 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $1,023 | | Total amount of fees paid to insurance company | USD $27 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,023 | | Amount paid for insurance broker fees | 27 | | Additional information about fees paid to insurance broker | NOT SPECIFIED ON SCHEDULE A | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19473 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19473 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $94,050 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $627,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $94,050 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES, INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $852 | | Total amount of fees paid to insurance company | USD $58 | | 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 $8,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $852 | | Amount paid for insurance broker fees | 58 | | Additional information about fees paid to insurance broker | NOT SPECIFIED ON SCHEDULE A | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19473 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19473 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $97,305 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $648,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $97,305 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES, INC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL19473 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL19473 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $86,030 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $573,534 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $86,030 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES, INC |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $812 | | Total amount of fees paid to insurance company | USD $87 | | 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 $8,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $812 | | Amount paid for insurance broker fees | 87 | | Additional information about fees paid to insurance broker | NOT SPECIFIED ON SCHEDULE A | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $800 | | Total amount of fees paid to insurance company | USD $92 | | 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 $7,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $800 | | Amount paid for insurance broker fees | 92 | | Additional information about fees paid to insurance broker | NOT SPECIFIED ON SCHEDULE A | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | |
| Policy instance | 1 |
| Number of Individuals Covered | 205 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $72,843 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $485,619 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $72,843 | | Insurance broker organization code? | 3 | | Insurance broker name | HEALEY & ASSOCIATES, INC |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | UHIC-102846 |
| Policy instance | 1 |
| Insurance contract or identification number | UHIC-102846 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $52,914 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $352,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $669 | | Total amount of fees paid to insurance company | USD $55 | | 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 $6,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | UHIC-102846 |
| Policy instance | 1 |
| Insurance contract or identification number | UHIC-102846 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $56,832 | | 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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $307,760 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-029131 |
| Policy instance | 2 |
| Insurance contract or identification number | 010-029131 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $737 | | 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 $6,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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