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MIDDLESEX SCHOOL LIFE INSURANCE PLAN 401k Plan overview

Plan NameMIDDLESEX SCHOOL LIFE INSURANCE PLAN
Plan identification number 504

MIDDLESEX SCHOOL LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MIDDLESEX SCHOOL has sponsored the creation of one or more 401k plans.

Company Name:MIDDLESEX SCHOOL
Employer identification number (EIN):042103821
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDDLESEX SCHOOL LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042012-06-01THERESE CUNNINGHAM
5042011-06-01THERESE CUNNINGHAM
5042010-06-01THERESE CUNNINGHAM
5042009-06-01THERESE CUNNINGHAM
5042008-06-01THERESE CUNNINGHAM
5042007-06-01THERESE CUNNINGHAM
5042006-06-01THERESE CUNNINGHAM
5042005-06-01THERESE CUNNINGHAM
5042004-06-01THERESE CUNNINGHAM
5042003-06-01THERESE CUNNINGHAM
5042002-06-01THERESE CUNNINGHAM
5042001-06-01THERESE CUNNINGHAM
5042000-06-01THERESE CUNNINGHAM
5041999-06-01THERESE CUNNINGHAM
5041998-06-01THERESE CUNNINGHAM
5041997-06-01THERESE CUNNINGHAM
5041996-06-01THERESE CUNNINGHAM
5041995-06-01THERESE CUNNINGHAM
5041994-06-01THERESE CUNNINGHAM
5041993-06-01THERESE CUNNINGHAM
5041992-06-01THERESE CUNNINGHAM
5041991-06-01THERESE CUNNINGHAM
5041990-06-01THERESE CUNNINGHAM
5041989-06-01THERESE CUNNINGHAM
5041988-06-01THERESE CUNNINGHAM

Plan Statistics for MIDDLESEX SCHOOL LIFE INSURANCE PLAN

401k plan membership statisitcs for MIDDLESEX SCHOOL LIFE INSURANCE PLAN

Measure Date Value
2012: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01148
Total number of active participants reported on line 7a of the Form 55002012-06-010
Number of retired or separated participants receiving benefits2012-06-010
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-010
2011: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01133
Total number of active participants reported on line 7a of the Form 55002011-06-01148
Number of retired or separated participants receiving benefits2011-06-010
Number of other retired or separated participants entitled to future benefits2011-06-010
Total of all active and inactive participants2011-06-01148
2010: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01136
Total number of active participants reported on line 7a of the Form 55002010-06-01141
Number of retired or separated participants receiving benefits2010-06-010
Number of other retired or separated participants entitled to future benefits2010-06-010
Total of all active and inactive participants2010-06-01141
2009: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01134
Total number of active participants reported on line 7a of the Form 55002009-06-01136
Number of retired or separated participants receiving benefits2009-06-010
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-01136
2008: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2008 401k membership
Total participants, beginning-of-year2008-06-01133
Total number of active participants reported on line 7a of the Form 55002008-06-01134
Number of retired or separated participants receiving benefits2008-06-010
Number of other retired or separated participants entitled to future benefits2008-06-010
Total of all active and inactive participants2008-06-01134
2007: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2007 401k membership
Total participants, beginning-of-year2007-06-01131
Total number of active participants reported on line 7a of the Form 55002007-06-01133
Number of retired or separated participants receiving benefits2007-06-010
Number of other retired or separated participants entitled to future benefits2007-06-010
Total of all active and inactive participants2007-06-01133
2006: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2006 401k membership
Total participants, beginning-of-year2006-06-01100
Total number of active participants reported on line 7a of the Form 55002006-06-01131
Number of retired or separated participants receiving benefits2006-06-010
Number of other retired or separated participants entitled to future benefits2006-06-010
Total of all active and inactive participants2006-06-01131
2005: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2005 401k membership
Total participants, beginning-of-year2005-06-01100
Total number of active participants reported on line 7a of the Form 55002005-06-01100
Number of retired or separated participants receiving benefits2005-06-010
Number of other retired or separated participants entitled to future benefits2005-06-010
Total of all active and inactive participants2005-06-01100
2004: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2004 401k membership
Total participants, beginning-of-year2004-06-01100
Total number of active participants reported on line 7a of the Form 55002004-06-01100
Number of retired or separated participants receiving benefits2004-06-010
Number of other retired or separated participants entitled to future benefits2004-06-010
Total of all active and inactive participants2004-06-01100
2003: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2003 401k membership
Total participants, beginning-of-year2003-06-01100
Total number of active participants reported on line 7a of the Form 55002003-06-01100
Number of retired or separated participants receiving benefits2003-06-010
Number of other retired or separated participants entitled to future benefits2003-06-010
Total of all active and inactive participants2003-06-01100
2002: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2002 401k membership
Total participants, beginning-of-year2002-06-01100
Total number of active participants reported on line 7a of the Form 55002002-06-01100
Number of retired or separated participants receiving benefits2002-06-010
Number of other retired or separated participants entitled to future benefits2002-06-010
Total of all active and inactive participants2002-06-01100
2001: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2001 401k membership
Total participants, beginning-of-year2001-06-01100
Total number of active participants reported on line 7a of the Form 55002001-06-01100
Number of retired or separated participants receiving benefits2001-06-010
Number of other retired or separated participants entitled to future benefits2001-06-010
Total of all active and inactive participants2001-06-01100
2000: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2000 401k membership
Total participants, beginning-of-year2000-06-01100
Total number of active participants reported on line 7a of the Form 55002000-06-01100
Number of retired or separated participants receiving benefits2000-06-010
Number of other retired or separated participants entitled to future benefits2000-06-010
Total of all active and inactive participants2000-06-01100
1999: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1999 401k membership
Total participants, beginning-of-year1999-06-01100
Total number of active participants reported on line 7a of the Form 55001999-06-01100
Number of retired or separated participants receiving benefits1999-06-010
Number of other retired or separated participants entitled to future benefits1999-06-010
Total of all active and inactive participants1999-06-01100
1998: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1998 401k membership
Total participants, beginning-of-year1998-06-01100
Total number of active participants reported on line 7a of the Form 55001998-06-01100
Number of retired or separated participants receiving benefits1998-06-010
Number of other retired or separated participants entitled to future benefits1998-06-010
Total of all active and inactive participants1998-06-01100
1997: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1997 401k membership
Total participants, beginning-of-year1997-06-01100
Total number of active participants reported on line 7a of the Form 55001997-06-01100
Number of retired or separated participants receiving benefits1997-06-010
Number of other retired or separated participants entitled to future benefits1997-06-010
Total of all active and inactive participants1997-06-01100
1996: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1996 401k membership
Total participants, beginning-of-year1996-06-01100
Total number of active participants reported on line 7a of the Form 55001996-06-01100
Number of retired or separated participants receiving benefits1996-06-010
Number of other retired or separated participants entitled to future benefits1996-06-010
Total of all active and inactive participants1996-06-01100
1995: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1995 401k membership
Total participants, beginning-of-year1995-06-01100
Total number of active participants reported on line 7a of the Form 55001995-06-01100
Number of retired or separated participants receiving benefits1995-06-010
Number of other retired or separated participants entitled to future benefits1995-06-010
Total of all active and inactive participants1995-06-01100
1994: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1994 401k membership
Total participants, beginning-of-year1994-06-01100
Total number of active participants reported on line 7a of the Form 55001994-06-01100
Number of retired or separated participants receiving benefits1994-06-010
Number of other retired or separated participants entitled to future benefits1994-06-010
Total of all active and inactive participants1994-06-01100
1993: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1993 401k membership
Total participants, beginning-of-year1993-06-01100
Total number of active participants reported on line 7a of the Form 55001993-06-01100
Number of retired or separated participants receiving benefits1993-06-010
Number of other retired or separated participants entitled to future benefits1993-06-010
Total of all active and inactive participants1993-06-01100
1992: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1992 401k membership
Total participants, beginning-of-year1992-06-01100
Total number of active participants reported on line 7a of the Form 55001992-06-01100
Number of retired or separated participants receiving benefits1992-06-010
Number of other retired or separated participants entitled to future benefits1992-06-010
Total of all active and inactive participants1992-06-01100
1991: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1991 401k membership
Total participants, beginning-of-year1991-06-01100
Total number of active participants reported on line 7a of the Form 55001991-06-01100
Number of retired or separated participants receiving benefits1991-06-010
Number of other retired or separated participants entitled to future benefits1991-06-010
Total of all active and inactive participants1991-06-01100
1990: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1990 401k membership
Total participants, beginning-of-year1990-06-01100
Total number of active participants reported on line 7a of the Form 55001990-06-01100
Number of retired or separated participants receiving benefits1990-06-010
Number of other retired or separated participants entitled to future benefits1990-06-010
Total of all active and inactive participants1990-06-01100
1989: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1989 401k membership
Total participants, beginning-of-year1989-06-01100
Total number of active participants reported on line 7a of the Form 55001989-06-01100
Number of retired or separated participants receiving benefits1989-06-010
Number of other retired or separated participants entitled to future benefits1989-06-010
Total of all active and inactive participants1989-06-01100
1988: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1988 401k membership
Total participants, beginning-of-year1988-06-01100
Total number of active participants reported on line 7a of the Form 55001988-06-01100
Number of retired or separated participants receiving benefits1988-06-010
Number of other retired or separated participants entitled to future benefits1988-06-010
Total of all active and inactive participants1988-06-01100

Form 5500 Responses for MIDDLESEX SCHOOL LIFE INSURANCE PLAN

2012: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingYes
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes
2008: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2008 form 5500 responses
2008-06-01Type of plan entitySingle employer plan
2008-06-01Submission has been amendedNo
2008-06-01This submission is the final filingNo
2008-06-01This return/report is a short plan year return/report (less than 12 months)No
2008-06-01Plan is a collectively bargained planNo
2008-06-01Plan funding arrangement – InsuranceYes
2008-06-01Plan benefit arrangement – InsuranceYes
2007: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2007 form 5500 responses
2007-06-01Type of plan entitySingle employer plan
2007-06-01Submission has been amendedNo
2007-06-01This submission is the final filingNo
2007-06-01This return/report is a short plan year return/report (less than 12 months)No
2007-06-01Plan is a collectively bargained planNo
2007-06-01Plan funding arrangement – InsuranceYes
2007-06-01Plan benefit arrangement – InsuranceYes
2006: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2006 form 5500 responses
2006-06-01Type of plan entitySingle employer plan
2006-06-01Submission has been amendedNo
2006-06-01This submission is the final filingNo
2006-06-01This return/report is a short plan year return/report (less than 12 months)No
2006-06-01Plan is a collectively bargained planNo
2006-06-01Plan funding arrangement – InsuranceYes
2006-06-01Plan benefit arrangement – InsuranceYes
2005: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2005 form 5500 responses
2005-06-01Type of plan entitySingle employer plan
2005-06-01Submission has been amendedNo
2005-06-01This submission is the final filingNo
2005-06-01This return/report is a short plan year return/report (less than 12 months)No
2005-06-01Plan is a collectively bargained planNo
2005-06-01Plan funding arrangement – InsuranceYes
2005-06-01Plan benefit arrangement – InsuranceYes
2004: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2004 form 5500 responses
2004-06-01Type of plan entitySingle employer plan
2004-06-01Submission has been amendedNo
2004-06-01This submission is the final filingNo
2004-06-01This return/report is a short plan year return/report (less than 12 months)No
2004-06-01Plan is a collectively bargained planNo
2004-06-01Plan funding arrangement – InsuranceYes
2004-06-01Plan benefit arrangement – InsuranceYes
2003: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2003 form 5500 responses
2003-06-01Type of plan entitySingle employer plan
2003-06-01Submission has been amendedNo
2003-06-01This submission is the final filingNo
2003-06-01This return/report is a short plan year return/report (less than 12 months)No
2003-06-01Plan is a collectively bargained planNo
2003-06-01Plan funding arrangement – InsuranceYes
2003-06-01Plan benefit arrangement – InsuranceYes
2002: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2002 form 5500 responses
2002-06-01Type of plan entitySingle employer plan
2002-06-01Submission has been amendedNo
2002-06-01This submission is the final filingNo
2002-06-01This return/report is a short plan year return/report (less than 12 months)No
2002-06-01Plan is a collectively bargained planNo
2002-06-01Plan funding arrangement – InsuranceYes
2002-06-01Plan benefit arrangement – InsuranceYes
2001: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2001 form 5500 responses
2001-06-01Type of plan entitySingle employer plan
2001-06-01Submission has been amendedNo
2001-06-01This submission is the final filingNo
2001-06-01This return/report is a short plan year return/report (less than 12 months)No
2001-06-01Plan is a collectively bargained planNo
2001-06-01Plan funding arrangement – InsuranceYes
2001-06-01Plan benefit arrangement – InsuranceYes
2000: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 2000 form 5500 responses
2000-06-01Type of plan entitySingle employer plan
2000-06-01Submission has been amendedNo
2000-06-01This submission is the final filingNo
2000-06-01This return/report is a short plan year return/report (less than 12 months)No
2000-06-01Plan is a collectively bargained planNo
2000-06-01Plan funding arrangement – InsuranceYes
2000-06-01Plan benefit arrangement – InsuranceYes
1999: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1999 form 5500 responses
1999-06-01Type of plan entitySingle employer plan
1999-06-01Submission has been amendedNo
1999-06-01This submission is the final filingNo
1999-06-01This return/report is a short plan year return/report (less than 12 months)No
1999-06-01Plan is a collectively bargained planNo
1999-06-01Plan funding arrangement – InsuranceYes
1999-06-01Plan benefit arrangement – InsuranceYes
1998: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1998 form 5500 responses
1998-06-01Type of plan entitySingle employer plan
1998-06-01Submission has been amendedNo
1998-06-01This submission is the final filingNo
1998-06-01This return/report is a short plan year return/report (less than 12 months)No
1998-06-01Plan is a collectively bargained planNo
1998-06-01Plan funding arrangement – InsuranceYes
1998-06-01Plan benefit arrangement – InsuranceYes
1997: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1997 form 5500 responses
1997-06-01Type of plan entitySingle employer plan
1997-06-01Submission has been amendedNo
1997-06-01This submission is the final filingNo
1997-06-01This return/report is a short plan year return/report (less than 12 months)No
1997-06-01Plan is a collectively bargained planNo
1997-06-01Plan funding arrangement – InsuranceYes
1997-06-01Plan benefit arrangement – InsuranceYes
1996: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1996 form 5500 responses
1996-06-01Type of plan entitySingle employer plan
1996-06-01Submission has been amendedNo
1996-06-01This submission is the final filingNo
1996-06-01This return/report is a short plan year return/report (less than 12 months)No
1996-06-01Plan is a collectively bargained planNo
1996-06-01Plan funding arrangement – InsuranceYes
1996-06-01Plan benefit arrangement – InsuranceYes
1995: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1995 form 5500 responses
1995-06-01Type of plan entitySingle employer plan
1995-06-01Submission has been amendedNo
1995-06-01This submission is the final filingNo
1995-06-01This return/report is a short plan year return/report (less than 12 months)No
1995-06-01Plan is a collectively bargained planNo
1995-06-01Plan funding arrangement – InsuranceYes
1995-06-01Plan benefit arrangement – InsuranceYes
1994: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1994 form 5500 responses
1994-06-01Type of plan entitySingle employer plan
1994-06-01Submission has been amendedNo
1994-06-01This submission is the final filingNo
1994-06-01This return/report is a short plan year return/report (less than 12 months)No
1994-06-01Plan is a collectively bargained planNo
1994-06-01Plan funding arrangement – InsuranceYes
1994-06-01Plan benefit arrangement – InsuranceYes
1993: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1993 form 5500 responses
1993-06-01Type of plan entitySingle employer plan
1993-06-01Submission has been amendedNo
1993-06-01This submission is the final filingNo
1993-06-01This return/report is a short plan year return/report (less than 12 months)No
1993-06-01Plan is a collectively bargained planNo
1993-06-01Plan funding arrangement – InsuranceYes
1993-06-01Plan benefit arrangement – InsuranceYes
1992: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1992 form 5500 responses
1992-06-01Type of plan entitySingle employer plan
1992-06-01Submission has been amendedNo
1992-06-01This submission is the final filingNo
1992-06-01This return/report is a short plan year return/report (less than 12 months)No
1992-06-01Plan is a collectively bargained planNo
1992-06-01Plan funding arrangement – InsuranceYes
1992-06-01Plan benefit arrangement – InsuranceYes
1991: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1991 form 5500 responses
1991-06-01Type of plan entitySingle employer plan
1991-06-01Submission has been amendedNo
1991-06-01This submission is the final filingNo
1991-06-01This return/report is a short plan year return/report (less than 12 months)No
1991-06-01Plan is a collectively bargained planNo
1991-06-01Plan funding arrangement – InsuranceYes
1991-06-01Plan benefit arrangement – InsuranceYes
1990: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1990 form 5500 responses
1990-06-01Type of plan entitySingle employer plan
1990-06-01Submission has been amendedNo
1990-06-01This submission is the final filingNo
1990-06-01This return/report is a short plan year return/report (less than 12 months)No
1990-06-01Plan is a collectively bargained planNo
1990-06-01Plan funding arrangement – InsuranceYes
1990-06-01Plan benefit arrangement – InsuranceYes
1989: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1989 form 5500 responses
1989-06-01Type of plan entitySingle employer plan
1989-06-01Submission has been amendedNo
1989-06-01This submission is the final filingNo
1989-06-01This return/report is a short plan year return/report (less than 12 months)No
1989-06-01Plan is a collectively bargained planNo
1989-06-01Plan funding arrangement – InsuranceYes
1989-06-01Plan benefit arrangement – InsuranceYes
1988: MIDDLESEX SCHOOL LIFE INSURANCE PLAN 1988 form 5500 responses
1988-06-01Type of plan entitySingle employer plan
1988-06-01First time form 5500 has been submittedYes
1988-06-01Submission has been amendedNo
1988-06-01This submission is the final filingNo
1988-06-01This return/report is a short plan year return/report (less than 12 months)No
1988-06-01Plan is a collectively bargained planNo
1988-06-01Plan funding arrangement – InsuranceYes
1988-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53873
Policy instance 1
Insurance contract or identification numberG53873
Number of Individuals Covered149
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $8,040
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $80,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,040
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH, INC.
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53873
Policy instance 1
Insurance contract or identification numberG53873
Number of Individuals Covered148
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53873
Policy instance 1
Insurance contract or identification numberG53873
Number of Individuals Covered141
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $8,573
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $73,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,573
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH, INC.
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG53873
Policy instance 1
Insurance contract or identification numberG53873
Number of Individuals Covered136
Insurance policy start date2008-10-01
Insurance policy end date2009-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2007-10-01
Insurance policy end date2008-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered133
Insurance policy start date2006-10-01
Insurance policy end date2007-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered131
Insurance policy start date2005-10-01
Insurance policy end date2006-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2004-10-01
Insurance policy end date2005-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2003-10-01
Insurance policy end date2004-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2002-10-01
Insurance policy end date2003-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2001-10-01
Insurance policy end date2002-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date2000-10-01
Insurance policy end date2001-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1999-10-01
Insurance policy end date2000-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1998-10-01
Insurance policy end date1999-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1997-10-01
Insurance policy end date1998-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1996-10-01
Insurance policy end date1997-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1995-10-01
Insurance policy end date1996-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1994-10-01
Insurance policy end date1995-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1993-10-01
Insurance policy end date1994-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1992-10-01
Insurance policy end date1993-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1991-10-01
Insurance policy end date1992-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1990-10-01
Insurance policy end date1991-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1989-10-01
Insurance policy end date1990-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1988-10-01
Insurance policy end date1989-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MHN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered100
Insurance policy start date1987-10-01
Insurance policy end date1988-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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