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VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 401k Plan overview

Plan NameVIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN
Plan identification number 501

VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

VIVA WELL SERVICING COMPANY, LP has sponsored the creation of one or more 401k plans.

Company Name:VIVA WELL SERVICING COMPANY, LP
Employer identification number (EIN):204250475
NAIC Classification:211120
NAIC Description:Crude Petroleum Extraction

Additional information about VIVA WELL SERVICING COMPANY, LP

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2005-12-22
Company Identification Number: 0800588243
Legal Registered Office Address: PO BOX 4437

ODESSA
United States of America (USA)
79760

More information about VIVA WELL SERVICING COMPANY, LP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01MIKE GIROIR
5012016-01-01MIKE GIROIR
5012015-01-01MIKE GIROIR
5012014-01-01MIKE GIROIR
5012013-01-01MIKE GIROIR
5012012-01-01MIKE GIROIR

Plan Statistics for VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN

401k plan membership statisitcs for VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN

Measure Date Value
2022: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01146
Total number of active participants reported on line 7a of the Form 55002022-01-01136
Total of all active and inactive participants2022-01-01136
Total participants2022-01-01136
2021: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01127
Total number of active participants reported on line 7a of the Form 55002021-01-01135
Total of all active and inactive participants2021-01-01135
Total participants2021-01-01135
2020: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01222
Total number of active participants reported on line 7a of the Form 55002020-01-01123
Total of all active and inactive participants2020-01-01123
Total participants2020-01-01123
2019: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01224
Total number of active participants reported on line 7a of the Form 55002019-01-01229
Total of all active and inactive participants2019-01-01229
Total participants2019-01-01229
2018: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01170
Total number of active participants reported on line 7a of the Form 55002018-01-01238
Total of all active and inactive participants2018-01-01238
Total participants2018-01-01238
2017: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01159
Total number of active participants reported on line 7a of the Form 55002017-01-01167
Total of all active and inactive participants2017-01-01167
Total participants2017-01-01167
2016: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01159
Total number of active participants reported on line 7a of the Form 55002016-01-01162
Total of all active and inactive participants2016-01-01162
Total participants2016-01-01162
2015: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01183
Total number of active participants reported on line 7a of the Form 55002015-01-01159
Total of all active and inactive participants2015-01-01159
Total participants2015-01-01159
2014: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01187
Total number of active participants reported on line 7a of the Form 55002014-01-01183
Total of all active and inactive participants2014-01-01183
Total participants2014-01-01183
2013: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01170
Total number of active participants reported on line 7a of the Form 55002013-01-01178
Total of all active and inactive participants2013-01-01178
Total participants2013-01-01178
2012: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01165
Total number of active participants reported on line 7a of the Form 55002012-01-01169
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01170
Total participants2012-01-01170

Financial Data on VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN

Measure Date Value
2017 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$3,108,570
Total of all expenses incurred2017-12-31$3,108,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,037,341
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$3,108,570
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$71,229
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$731,884
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$625,680
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$2,376,686
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$2,411,661
Contract administrator fees2017-12-31$71,229
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31Yes
2016 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$2,930,758
Total of all expenses incurred2016-12-31$2,930,758
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,819,559
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,930,758
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$111,199
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$568,489
Administrative expenses (other) incurred2016-12-31$38,279
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$402,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$2,362,269
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,417,229
Contract administrator fees2016-12-31$72,920
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31Yes
2015 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2015 401k financial data
Total income from all sources (including contributions)2015-12-31$1,715,153
Total of all expenses incurred2015-12-31$1,715,153
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,595,207
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,715,153
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$119,946
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$650,026
Administrative expenses (other) incurred2015-12-31$42,551
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$514,769
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,065,127
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,080,438
Contract administrator fees2015-12-31$77,395
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31Yes
2014 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-12-31$1,526,178
Total of all expenses incurred2014-12-31$1,526,178
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,409,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,526,178
Value of total assets at beginning of year2014-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$116,588
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$574,982
Administrative expenses (other) incurred2014-12-31$40,996
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$464,479
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$951,196
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$945,111
Contract administrator fees2014-12-31$75,592
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31Yes
2013 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-12-31$1,405,942
Total of all expenses incurred2013-12-31$1,405,942
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,295,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,405,942
Value of total assets at end of year2013-12-31$0
Value of total assets at beginning of year2013-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$110,754
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$475,541
Administrative expenses (other) incurred2013-12-31$37,965
Total non interest bearing cash at end of year2013-12-31$0
Total non interest bearing cash at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$430,080
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$930,401
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$865,108
Contract administrator fees2013-12-31$72,789
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31Yes
2012 : VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$1,114,678
Total of all expenses incurred2012-12-31$1,114,678
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$1,010,002
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,114,678
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$104,676
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31No
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$410,586
Administrative expenses (other) incurred2012-12-31$36,450
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$402,725
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$704,092
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$607,277
Contract administrator fees2012-12-31$68,226
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31Yes

Form 5500 Responses for VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN

2022: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: VIVA WELL SERVICING COMPANY HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913878
Policy instance 1
Insurance contract or identification number913878
Number of Individuals Covered652
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,574
Total amount of fees paid to insurance companyUSD $152,502
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBASIC AD&D
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 $3,144,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $330
Insurance broker organization code?3
Amount paid for insurance broker fees152502
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913878
Policy instance 1
Insurance contract or identification number913878
Number of Individuals Covered418
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $106,440
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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
Welfare Benefit Premiums Paid to CarrierUSD $2,081,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-34
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913878
Policy instance 1
Insurance contract or identification number913878
Number of Individuals Covered316
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,050
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 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
Commission paid to Insurance BrokerUSD $2,050
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number913878
Policy instance 1
Insurance contract or identification number913878
Number of Individuals Covered561
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $13,798
Total amount of fees paid to insurance companyUSD $145,671
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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
Welfare Benefit Premiums Paid to CarrierUSD $2,908,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,798
Amount paid for insurance broker fees145671
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberSVIVA00
Policy instance 3
Insurance contract or identification numberSVIVA00
Number of Individuals Covered167
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,833
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $28,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,833
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberSVIVA00
Policy instance 2
Insurance contract or identification numberSVIVA00
Number of Individuals Covered167
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,838
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,919
Insurance broker organization code?5
Insurance broker nameINSOURCE INSURANCE GROUP, LLC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberSVIVA00
Policy instance 1
Insurance contract or identification numberSVIVA00
Number of Individuals Covered167
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $60,297
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $577,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees40399
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberSVIVA00
Policy instance 3
Insurance contract or identification numberSVIVA00
Number of Individuals Covered159
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,152
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $23,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,152
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberSVIVA00
Policy instance 2
Insurance contract or identification numberSVIVA00
Number of Individuals Covered160
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,236
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,118
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberSVIVA00
Policy instance 1
Insurance contract or identification numberSVIVA00
Number of Individuals Covered159
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $63,106
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $470,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees42071
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )
Policy contract numberSVIVA00
Policy instance 3
Insurance contract or identification numberSVIVA00
Number of Individuals Covered183
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $21,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberSVIVA00
Policy instance 2
Insurance contract or identification numberSVIVA00
Number of Individuals Covered183
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,776
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,888
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
INTERMEDIARY INSURANCE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 52413 )
Policy contract numberSVIVA00
Policy instance 1
Insurance contract or identification numberSVIVA00
Number of Individuals Covered183
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $55,806
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $422,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees40560
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
INTERMEDIARY INSURANCE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 52413 )
Policy contract numberSVIVA00
Policy instance 3
Insurance contract or identification numberSVIVA00
Number of Individuals Covered178
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of fees paid to insurance companyUSD $51,720
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $380,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees37580
Additional information about fees paid to insurance brokerREINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberSVIVA00
Policy instance 2
Insurance contract or identification numberSVIVA00
Number of Individuals Covered178
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,274
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $2,137
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberSVIVA00
Policy instance 1
Insurance contract or identification numberSVIVA00
Number of Individuals Covered178
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,797
Other welfare benefits providedTRANSPLANT POLICY
Welfare Benefit Premiums Paid to CarrierUSD $37,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,797
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT SERVICES
INTERMEDIARY INSURANCE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 52413 )
Policy contract numberSVIVA00
Policy instance 3
Insurance contract or identification numberSVIVA00
Number of Individuals Covered170
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $355,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberSVIVA00
Policy instance 2
Insurance contract or identification numberSVIVA00
Number of Individuals Covered170
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,728
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,364
Insurance broker organization code?3
Insurance broker nameINSURANCE MANAGEMENT SERVICES
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberSVIVA00
Policy instance 1
Insurance contract or identification numberSVIVA00
Number of Individuals Covered170
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,393
Other welfare benefits providedTRANSPLANT PLAN
Welfare Benefit Premiums Paid to CarrierUSD $23,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,393
Insurance broker organization code?5
Insurance broker nameINSURANCE MANAGEMENT SERVICES

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