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HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameHEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN
Plan identification number 501

HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

HEALTHCARE REIMBURSEMENT ADVISORS, INC. has sponsored the creation of one or more 401k plans.

Company Name:HEALTHCARE REIMBURSEMENT ADVISORS, INC.
Employer identification number (EIN):201254409
NAIC Classification:541219
NAIC Description:Other Accounting Services

Additional information about HEALTHCARE REIMBURSEMENT ADVISORS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2004-06-01
Company Identification Number: P04000085666
Legal Registered Office Address: 3497 OAK KNOLL PT

LAKE MARY

32746

More information about HEALTHCARE REIMBURSEMENT ADVISORS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01WILLIAM NUTT2023-05-17
5012020-12-01WILLIAM NUTT2022-05-26
5012019-12-01WILLIAM NUTT2021-05-18
5012018-12-01WILLIAM NUTT2020-09-14
5012017-12-01WILLIAM NUTT WILLIAM NUTT2019-03-12
5012016-12-01WILLIAM NUTT WILLIAM NUTT2018-03-20
5012015-12-01WILLIAM NUTT
5012014-12-01WILLIAM NUTT
5012013-12-01WILLIAM NUTT
5012012-12-01WILLIAM NUTT WILLIAM NUTT2014-06-12
5012011-12-01WILLIAM NUTT
5012009-12-01WILLIAM NUTT

Plan Statistics for HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2021: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-011
Total number of active participants reported on line 7a of the Form 55002021-12-011
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-011
Total participants2021-12-011
2020: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-011
Total number of active participants reported on line 7a of the Form 55002020-12-011
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-011
Total participants2020-12-011
2019: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-011
Total number of active participants reported on line 7a of the Form 55002019-12-011
Number of retired or separated participants receiving benefits2019-12-010
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-011
Total participants2019-12-011
2018: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-011
Total number of active participants reported on line 7a of the Form 55002018-12-011
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-12-010
Total participants2018-12-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-12-010
2017: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-011
Total number of active participants reported on line 7a of the Form 55002017-12-011
Number of retired or separated participants receiving benefits2017-12-010
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-12-010
Total participants2017-12-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-12-010
2016: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-011
Total number of active participants reported on line 7a of the Form 55002016-12-011
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-12-010
Total participants2016-12-011
2015: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-011
Total number of active participants reported on line 7a of the Form 55002015-12-011
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-12-010
Total participants2015-12-011
2014: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-011
Total number of active participants reported on line 7a of the Form 55002014-12-011
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-12-010
Total participants2014-12-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-12-010
2013: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-012
Total number of active participants reported on line 7a of the Form 55002013-12-011
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-011
Total participants2013-12-011
2012: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-012
Total number of active participants reported on line 7a of the Form 55002012-12-012
Number of retired or separated participants receiving benefits2012-12-010
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-012
Total participants2012-12-012
2011: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-012
Total number of active participants reported on line 7a of the Form 55002011-12-012
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-012
2009: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-012
Total number of active participants reported on line 7a of the Form 55002009-12-012
Number of retired or separated participants receiving benefits2009-12-010
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-012

Financial Data on HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-11-30$5,243
Expenses. Total of all expenses incurred2022-11-30$0
Total plan assets at end of year2022-11-30$314,136
Total plan assets at beginning of year2022-11-30$308,893
Other income received2022-11-30$5,243
Net income (gross income less expenses)2022-11-30$5,243
Net plan assets at end of year (total assets less liabilities)2022-11-30$314,136
Net plan assets at beginning of year (total assets less liabilities)2022-11-30$308,893
2021 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-11-30$54,857
Expenses. Total of all expenses incurred2021-11-30$0
Total plan assets at end of year2021-11-30$308,893
Total plan assets at beginning of year2021-11-30$254,036
Other income received2021-11-30$54,857
Net income (gross income less expenses)2021-11-30$54,857
Net plan assets at end of year (total assets less liabilities)2021-11-30$308,893
Net plan assets at beginning of year (total assets less liabilities)2021-11-30$254,036
Total contributions received or receivable from employer(s)2021-11-30$0
2020 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-11-30$8,627
Expenses. Total of all expenses incurred2020-11-30$0
Total plan assets at end of year2020-11-30$254,036
Total plan assets at beginning of year2020-11-30$245,409
Other income received2020-11-30$8,627
Net income (gross income less expenses)2020-11-30$8,627
Net plan assets at end of year (total assets less liabilities)2020-11-30$254,036
Net plan assets at beginning of year (total assets less liabilities)2020-11-30$245,409
Total contributions received or receivable from employer(s)2020-11-30$0
2019 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2019 401k financial data
Total income from all sources2019-11-30$30,506
Expenses. Total of all expenses incurred2019-11-30$0
Total plan assets at end of year2019-11-30$245,409
Total plan assets at beginning of year2019-11-30$214,903
Other income received2019-11-30$30,506
Net income (gross income less expenses)2019-11-30$30,506
Net plan assets at end of year (total assets less liabilities)2019-11-30$245,409
Net plan assets at beginning of year (total assets less liabilities)2019-11-30$214,903
Total contributions received or receivable from employer(s)2019-11-30$0
2018 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-11-30$-2,899
Expenses. Total of all expenses incurred2018-11-30$0
Total plan assets at end of year2018-11-30$214,903
Total plan assets at beginning of year2018-11-30$217,802
Other income received2018-11-30$-2,899
Net income (gross income less expenses)2018-11-30$-2,899
Net plan assets at end of year (total assets less liabilities)2018-11-30$214,903
Net plan assets at beginning of year (total assets less liabilities)2018-11-30$217,802
Total contributions received or receivable from employer(s)2018-11-30$0
2017 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2017 401k financial data
Transfers to/from the plan2017-11-30$0
Total income from all sources2017-11-30$6,793
Expenses. Total of all expenses incurred2017-11-30$0
Total plan assets at end of year2017-11-30$217,802
Total plan assets at beginning of year2017-11-30$211,009
Other income received2017-11-30$6,793
Net income (gross income less expenses)2017-11-30$6,793
Net plan assets at end of year (total assets less liabilities)2017-11-30$217,802
Net plan assets at beginning of year (total assets less liabilities)2017-11-30$211,009
Total contributions received or receivable from employer(s)2017-11-30$0
2016 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2016 401k financial data
Transfers to/from the plan2016-11-30$0
Total plan liabilities at end of year2016-11-30$0
Total plan liabilities at beginning of year2016-11-30$0
Total income from all sources2016-11-30$3,924
Expenses. Total of all expenses incurred2016-11-30$0
Total plan assets at end of year2016-11-30$211,009
Total plan assets at beginning of year2016-11-30$207,085
Other income received2016-11-30$3,924
Net income (gross income less expenses)2016-11-30$3,924
Net plan assets at end of year (total assets less liabilities)2016-11-30$211,009
Net plan assets at beginning of year (total assets less liabilities)2016-11-30$207,085
Total contributions received or receivable from employer(s)2016-11-30$0
2015 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-11-30$0
Total plan liabilities at beginning of year2015-11-30$0
Total income from all sources2015-11-30$732
Expenses. Total of all expenses incurred2015-11-30$211,684
Total plan assets at end of year2015-11-30$207,085
Total plan assets at beginning of year2015-11-30$418,037
Other income received2015-11-30$732
Net income (gross income less expenses)2015-11-30$-210,952
Net plan assets at end of year (total assets less liabilities)2015-11-30$207,085
Net plan assets at beginning of year (total assets less liabilities)2015-11-30$418,037
Total contributions received or receivable from employer(s)2015-11-30$0
Value of corrective distributions2015-11-30$211,318
Expenses. Administrative service providers (salaries,fees and commissions)2015-11-30$366
2014 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-11-30$418,037
Total plan liabilities at beginning of year2014-11-30$422,005
Total income from all sources2014-11-30$0
Expenses. Total of all expenses incurred2014-11-30$0
Total plan assets at end of year2014-11-30$418,037
Total plan assets at beginning of year2014-11-30$422,005
Net income (gross income less expenses)2014-11-30$0
Net plan assets at end of year (total assets less liabilities)2014-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2014-11-30$0
Total contributions received or receivable from employer(s)2014-11-30$0
2013 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2013 401k financial data
Total plan liabilities at end of year2013-11-30$422,005
Total plan liabilities at beginning of year2013-11-30$410,629
Total income from all sources2013-11-30$1,360
Expenses. Total of all expenses incurred2013-11-30$1,360
Total plan assets at end of year2013-11-30$422,005
Total plan assets at beginning of year2013-11-30$410,629
Net income (gross income less expenses)2013-11-30$0
Net plan assets at end of year (total assets less liabilities)2013-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2013-11-30$0
Total contributions received or receivable from employer(s)2013-11-30$1,360
Expenses. Administrative service providers (salaries,fees and commissions)2013-11-30$1,360
2012 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2012 401k financial data
Total plan liabilities at end of year2012-11-30$410,629
Total plan liabilities at beginning of year2012-11-30$396,845
Total income from all sources2012-11-30$1,360
Expenses. Total of all expenses incurred2012-11-30$1,360
Total plan assets at end of year2012-11-30$410,629
Total plan assets at beginning of year2012-11-30$396,845
Net income (gross income less expenses)2012-11-30$0
Net plan assets at end of year (total assets less liabilities)2012-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2012-11-30$0
Total contributions received or receivable from employer(s)2012-11-30$1,360
Expenses. Administrative service providers (salaries,fees and commissions)2012-11-30$1,360
2011 : HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2011 401k financial data
Total plan liabilities at end of year2011-11-30$396,845
Total plan liabilities at beginning of year2011-11-30$377,368
Total income from all sources2011-11-30$1,360
Expenses. Total of all expenses incurred2011-11-30$1,360
Total plan assets at end of year2011-11-30$396,845
Total plan assets at beginning of year2011-11-30$377,368
Net income (gross income less expenses)2011-11-30$0
Net plan assets at end of year (total assets less liabilities)2011-11-30$0
Net plan assets at beginning of year (total assets less liabilities)2011-11-30$0
Total contributions received or receivable from employer(s)2011-11-30$1,360
Expenses. Administrative service providers (salaries,fees and commissions)2011-11-30$1,360

Form 5500 Responses for HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN

2021: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement - TrustYes
2020: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement - TrustYes
2019: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan benefit arrangement - TrustYes
2018: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan benefit arrangement - TrustYes
2017: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan benefit arrangement - TrustYes
2016: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement - TrustYes
2015: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement - TrustYes
2014: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement - TrustYes
2013: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement - TrustYes
2012: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan funding arrangement – TrustYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement - TrustYes
2011: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement - TrustYes
2009: HEALTHCARE REIMBURSEMENT ADVISORS, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01First time form 5500 has been submittedYes
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – TrustYes
2009-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number5318
Policy instance 1
Insurance contract or identification number5318
Number of Individuals Covered2
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,360
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedANNUITY
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?No
Amount paid for insurance broker fees1360
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameCJA & ASSOCIATES, INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number5318
Policy instance 1
Insurance contract or identification number5318
Number of Individuals Covered2
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,360
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedANNUITY
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?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number5318
Policy instance 1
Insurance contract or identification number5318
Number of Individuals Covered2
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,360
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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?No

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