WARM HEARTH INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WARM HEARTH WELFARE BENEFITS PLAN
Measure | Date | Value |
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2021: WARM HEARTH WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 165 |
Total of all active and inactive participants | 2021-10-01 | 165 |
2020: WARM HEARTH WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 117 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 116 |
Total of all active and inactive participants | 2020-10-01 | 116 |
2018: WARM HEARTH WELFARE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 134 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 123 |
Total of all active and inactive participants | 2018-10-01 | 123 |
2017: WARM HEARTH WELFARE BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 146 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 134 |
Total of all active and inactive participants | 2017-10-01 | 134 |
2016: WARM HEARTH WELFARE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 146 |
Total of all active and inactive participants | 2016-10-01 | 146 |
Total participants | 2016-10-01 | 146 |
2015: WARM HEARTH WELFARE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 187 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 139 |
Total of all active and inactive participants | 2015-10-01 | 139 |
Total participants | 2015-10-01 | 139 |
Total participants, beginning-of-year | 2015-04-01 | 187 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 187 |
Total of all active and inactive participants | 2015-04-01 | 187 |
Total participants | 2015-04-01 | 187 |
2014: WARM HEARTH WELFARE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-04-01 | 167 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 187 |
Total of all active and inactive participants | 2014-04-01 | 187 |
Total participants | 2014-04-01 | 187 |
2013: WARM HEARTH WELFARE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-04-01 | 172 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 167 |
Total of all active and inactive participants | 2013-04-01 | 167 |
Total participants | 2013-04-01 | 167 |
2012: WARM HEARTH WELFARE BENEFITS PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-04-01 | 178 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 172 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
Total of all active and inactive participants | 2012-04-01 | 172 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-04-01 | 0 |
Total participants | 2012-04-01 | 172 |
2011: WARM HEARTH WELFARE BENEFITS PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-04-01 | 175 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 178 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
Total of all active and inactive participants | 2011-04-01 | 178 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-04-01 | 0 |
Total participants | 2011-04-01 | 178 |
2010: WARM HEARTH WELFARE BENEFITS PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-04-01 | 171 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 175 |
Number of retired or separated participants receiving benefits | 2010-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-04-01 | 0 |
Total of all active and inactive participants | 2010-04-01 | 175 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-04-01 | 0 |
Total participants | 2010-04-01 | 175 |
2009: WARM HEARTH WELFARE BENEFITS PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-04-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 171 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
Total of all active and inactive participants | 2009-04-01 | 171 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-04-01 | 0 |
Total participants | 2009-04-01 | 171 |
2008: WARM HEARTH WELFARE BENEFITS PLAN 2008 401k membership |
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Total participants, beginning-of-year | 2008-04-01 | 156 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-04-01 | 166 |
Number of retired or separated participants receiving benefits | 2008-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2008-04-01 | 0 |
Total of all active and inactive participants | 2008-04-01 | 166 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-04-01 | 0 |
Total participants | 2008-04-01 | 166 |
2007: WARM HEARTH WELFARE BENEFITS PLAN 2007 401k membership |
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Total participants, beginning-of-year | 2007-04-01 | 158 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-04-01 | 160 |
Number of retired or separated participants receiving benefits | 2007-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2007-04-01 | 0 |
Total of all active and inactive participants | 2007-04-01 | 160 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2007-04-01 | 0 |
Total participants | 2007-04-01 | 160 |
2006: WARM HEARTH WELFARE BENEFITS PLAN 2006 401k membership |
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Total participants, beginning-of-year | 2006-04-01 | 161 |
Total number of active participants reported on line 7a of the Form 5500 | 2006-04-01 | 166 |
Number of retired or separated participants receiving benefits | 2006-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2006-04-01 | 0 |
Total of all active and inactive participants | 2006-04-01 | 166 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2006-04-01 | 0 |
Total participants | 2006-04-01 | 166 |
2005: WARM HEARTH WELFARE BENEFITS PLAN 2005 401k membership |
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Total participants, beginning-of-year | 2005-04-01 | 151 |
Total number of active participants reported on line 7a of the Form 5500 | 2005-04-01 | 170 |
Number of retired or separated participants receiving benefits | 2005-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2005-04-01 | 0 |
Total of all active and inactive participants | 2005-04-01 | 170 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2005-04-01 | 0 |
Total participants | 2005-04-01 | 170 |
2004: WARM HEARTH WELFARE BENEFITS PLAN 2004 401k membership |
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Total participants, beginning-of-year | 2004-04-01 | 142 |
Total number of active participants reported on line 7a of the Form 5500 | 2004-04-01 | 160 |
Number of retired or separated participants receiving benefits | 2004-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2004-04-01 | 0 |
Total of all active and inactive participants | 2004-04-01 | 160 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2004-04-01 | 0 |
Total participants | 2004-04-01 | 160 |
2003: WARM HEARTH WELFARE BENEFITS PLAN 2003 401k membership |
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Total participants, beginning-of-year | 2003-04-01 | 129 |
Total number of active participants reported on line 7a of the Form 5500 | 2003-04-01 | 143 |
Number of retired or separated participants receiving benefits | 2003-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2003-04-01 | 0 |
Total of all active and inactive participants | 2003-04-01 | 143 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2003-04-01 | 0 |
Total participants | 2003-04-01 | 143 |
2002: WARM HEARTH WELFARE BENEFITS PLAN 2002 401k membership |
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Total participants, beginning-of-year | 2002-04-01 | 137 |
Total number of active participants reported on line 7a of the Form 5500 | 2002-04-01 | 129 |
Number of retired or separated participants receiving benefits | 2002-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2002-04-01 | 0 |
Total of all active and inactive participants | 2002-04-01 | 129 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2002-04-01 | 0 |
Total participants | 2002-04-01 | 129 |
2001: WARM HEARTH WELFARE BENEFITS PLAN 2001 401k membership |
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Total participants, beginning-of-year | 2001-04-01 | 127 |
Total number of active participants reported on line 7a of the Form 5500 | 2001-04-01 | 133 |
Number of retired or separated participants receiving benefits | 2001-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2001-04-01 | 0 |
Total of all active and inactive participants | 2001-04-01 | 133 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2001-04-01 | 0 |
Total participants | 2001-04-01 | 133 |
2021: WARM HEARTH WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2020: WARM HEARTH WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2018: WARM HEARTH WELFARE BENEFITS PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: WARM HEARTH WELFARE BENEFITS PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: WARM HEARTH WELFARE BENEFITS PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: WARM HEARTH WELFARE BENEFITS PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Submission has been amended | No |
2015-04-01 | This submission is the final filing | No |
2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2015-04-01 | Plan is a collectively bargained plan | No |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: WARM HEARTH WELFARE BENEFITS PLAN 2014 form 5500 responses |
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2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Submission has been amended | No |
2014-04-01 | This submission is the final filing | No |
2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-04-01 | Plan is a collectively bargained plan | No |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: WARM HEARTH WELFARE BENEFITS PLAN 2013 form 5500 responses |
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2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Submission has been amended | No |
2013-04-01 | This submission is the final filing | No |
2013-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-04-01 | Plan is a collectively bargained plan | No |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2012: WARM HEARTH WELFARE BENEFITS PLAN 2012 form 5500 responses |
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2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Submission has been amended | No |
2012-04-01 | This submission is the final filing | No |
2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-04-01 | Plan is a collectively bargained plan | No |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: WARM HEARTH WELFARE BENEFITS PLAN 2011 form 5500 responses |
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2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Submission has been amended | No |
2011-04-01 | This submission is the final filing | No |
2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-04-01 | Plan is a collectively bargained plan | No |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: WARM HEARTH WELFARE BENEFITS PLAN 2010 form 5500 responses |
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2010-04-01 | Type of plan entity | Single employer plan |
2010-04-01 | Submission has been amended | No |
2010-04-01 | This submission is the final filing | No |
2010-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-04-01 | Plan is a collectively bargained plan | No |
2010-04-01 | Plan funding arrangement – Insurance | Yes |
2010-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-04-01 | Plan benefit arrangement – Insurance | Yes |
2010-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: WARM HEARTH WELFARE BENEFITS PLAN 2009 form 5500 responses |
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2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2008: WARM HEARTH WELFARE BENEFITS PLAN 2008 form 5500 responses |
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2008-04-01 | Type of plan entity | Single employer plan |
2008-04-01 | First time form 5500 has been submitted | Yes |
2008-04-01 | Submission has been amended | No |
2008-04-01 | This submission is the final filing | No |
2008-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-04-01 | Plan is a collectively bargained plan | No |
2008-04-01 | Plan funding arrangement – Insurance | Yes |
2008-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2008-04-01 | Plan benefit arrangement – Insurance | Yes |
2008-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2007: WARM HEARTH WELFARE BENEFITS PLAN 2007 form 5500 responses |
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2007-04-01 | Type of plan entity | Single employer plan |
2007-04-01 | First time form 5500 has been submitted | Yes |
2007-04-01 | Submission has been amended | No |
2007-04-01 | This submission is the final filing | No |
2007-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2007-04-01 | Plan is a collectively bargained plan | No |
2007-04-01 | Plan funding arrangement – Insurance | Yes |
2007-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2007-04-01 | Plan benefit arrangement – Insurance | Yes |
2007-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2006: WARM HEARTH WELFARE BENEFITS PLAN 2006 form 5500 responses |
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2006-04-01 | Type of plan entity | Single employer plan |
2006-04-01 | First time form 5500 has been submitted | Yes |
2006-04-01 | Submission has been amended | No |
2006-04-01 | This submission is the final filing | No |
2006-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2006-04-01 | Plan is a collectively bargained plan | No |
2006-04-01 | Plan funding arrangement – Insurance | Yes |
2006-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2006-04-01 | Plan benefit arrangement – Insurance | Yes |
2006-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2005: WARM HEARTH WELFARE BENEFITS PLAN 2005 form 5500 responses |
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2005-04-01 | Type of plan entity | Single employer plan |
2005-04-01 | First time form 5500 has been submitted | Yes |
2005-04-01 | Submission has been amended | No |
2005-04-01 | This submission is the final filing | No |
2005-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2005-04-01 | Plan is a collectively bargained plan | No |
2005-04-01 | Plan funding arrangement – Insurance | Yes |
2005-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2005-04-01 | Plan benefit arrangement – Insurance | Yes |
2005-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2004: WARM HEARTH WELFARE BENEFITS PLAN 2004 form 5500 responses |
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2004-04-01 | Type of plan entity | Single employer plan |
2004-04-01 | First time form 5500 has been submitted | Yes |
2004-04-01 | Submission has been amended | No |
2004-04-01 | This submission is the final filing | No |
2004-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2004-04-01 | Plan is a collectively bargained plan | No |
2004-04-01 | Plan funding arrangement – Insurance | Yes |
2004-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2004-04-01 | Plan benefit arrangement – Insurance | Yes |
2004-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2003: WARM HEARTH WELFARE BENEFITS PLAN 2003 form 5500 responses |
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2003-04-01 | Type of plan entity | Single employer plan |
2003-04-01 | First time form 5500 has been submitted | Yes |
2003-04-01 | Submission has been amended | No |
2003-04-01 | This submission is the final filing | No |
2003-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2003-04-01 | Plan is a collectively bargained plan | No |
2003-04-01 | Plan funding arrangement – Insurance | Yes |
2003-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2003-04-01 | Plan benefit arrangement – Insurance | Yes |
2003-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2002: WARM HEARTH WELFARE BENEFITS PLAN 2002 form 5500 responses |
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2002-04-01 | Type of plan entity | Single employer plan |
2002-04-01 | First time form 5500 has been submitted | Yes |
2002-04-01 | Submission has been amended | No |
2002-04-01 | This submission is the final filing | No |
2002-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2002-04-01 | Plan is a collectively bargained plan | No |
2002-04-01 | Plan funding arrangement – Insurance | Yes |
2002-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2002-04-01 | Plan benefit arrangement – Insurance | Yes |
2002-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2001: WARM HEARTH WELFARE BENEFITS PLAN 2001 form 5500 responses |
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2001-04-01 | Type of plan entity | Single employer plan |
2001-04-01 | First time form 5500 has been submitted | Yes |
2001-04-01 | Submission has been amended | No |
2001-04-01 | This submission is the final filing | No |
2001-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2001-04-01 | Plan is a collectively bargained plan | No |
2001-04-01 | Plan funding arrangement – Insurance | Yes |
2001-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2001-04-01 | Plan benefit arrangement – Insurance | Yes |
2001-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
Policy contract number | 052607 |
Policy instance | 6 |
Insurance contract or identification number | 052607 | Number of Individuals Covered | 146 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,196 | 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 number | 99200261001 |
Policy instance | 1 |
Insurance contract or identification number | 99200261001 | Number of Individuals Covered | 150 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $1,050 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,603 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,050 | Insurance broker organization code? | 3 |
|
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01417-20 |
Policy instance | 2 |
Insurance contract or identification number | LGS01417-20 | Number of Individuals Covered | 124 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,645 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $407,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1645 | Additional information about fees paid to insurance broker | SUUPLEMENTAL COMPENSATION PAID | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160298 |
Policy instance | 3 |
Insurance contract or identification number | 160298 | Number of Individuals Covered | 165 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $10,895 | Total amount of fees paid to insurance company | USD $1,313 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,664 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1313 | Additional information about fees paid to insurance broker | ADMINISTRATION |
|
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0010549169 |
Policy instance | 4 |
Insurance contract or identification number | 0010549169 | Number of Individuals Covered | 36 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-10-01 | Total amount of commissions paid to insurance broker | USD $541 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,755 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $378 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0579300 |
Policy instance | 5 |
Insurance contract or identification number | R0579300 | Number of Individuals Covered | 69 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-10-01 | Total amount of commissions paid to insurance broker | USD $1,169 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | Welfare Benefit Premiums Paid to Carrier | USD $17,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $819 | Insurance broker organization code? | 3 |
|
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01417-20 |
Policy instance | 3 |
Insurance contract or identification number | LGS01417-20 | Number of Individuals Covered | 124 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,900 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $355,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1900 | Additional information about fees paid to insurance broker | OTHER COMPENSATION PAID | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 99200261001 |
Policy instance | 2 |
Insurance contract or identification number | 99200261001 | Number of Individuals Covered | 164 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $1,027 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,985 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,027 | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160298 |
Policy instance | 4 |
Insurance contract or identification number | 160298 | Number of Individuals Covered | 173 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $9,991 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,714 | Insurance broker organization code? | 3 |
|
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0010549169 |
Policy instance | 5 |
Insurance contract or identification number | 0010549169 | Number of Individuals Covered | 46 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-10-01 | Total amount of commissions paid to insurance broker | USD $732 | Total amount of fees paid to insurance company | USD $20 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $512 | Amount paid for insurance broker fees | 17 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0579300 |
Policy instance | 6 |
Insurance contract or identification number | R0579300 | Number of Individuals Covered | 87 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-10-01 | Total amount of commissions paid to insurance broker | USD $1,686 | Total amount of fees paid to insurance company | USD $85 | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | Welfare Benefit Premiums Paid to Carrier | USD $21,653 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,181 | Amount paid for insurance broker fees | 72 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
Policy contract number | 52607 |
Policy instance | 1 |
Insurance contract or identification number | 52607 | Number of Individuals Covered | 149 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160298 |
Policy instance | 4 |
Insurance contract or identification number | 160298 | Number of Individuals Covered | 183 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $11,174 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,886 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 99200261001 |
Policy instance | 2 |
Insurance contract or identification number | 99200261001 | Number of Individuals Covered | 169 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $1,329 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,329 | Insurance broker organization code? | 3 |
|
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 ) |
Policy contract number | 052607 |
Policy instance | 1 |
Insurance contract or identification number | 052607 | Number of Individuals Covered | 155 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01417-18 |
Policy instance | 3 |
Insurance contract or identification number | LGS01417-18 | Number of Individuals Covered | 139 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $4,404 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $259,391 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 4404 | Additional information about fees paid to insurance broker | OTHER COMPENSATION PAID | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0010549169 |
Policy instance | 5 |
Insurance contract or identification number | 0010549169 | Number of Individuals Covered | 74 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,322 | Total amount of fees paid to insurance company | USD $253 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,109 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,024 | Amount paid for insurance broker fees | 251 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0579300 |
Policy instance | 6 |
Insurance contract or identification number | R0579300 | Number of Individuals Covered | 131 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $6,369 | Total amount of fees paid to insurance company | USD $8 | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | Welfare Benefit Premiums Paid to Carrier | USD $29,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,459 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 8 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 160298 |
Policy instance | 4 |
Insurance contract or identification number | 160298 | Number of Individuals Covered | 195 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $10,299 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,047 | Insurance broker organization code? | 3 |
|
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0010549169 |
Policy instance | 5 |
Insurance contract or identification number | 0010549169 | Number of Individuals Covered | 74 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $3,289 | Total amount of fees paid to insurance company | USD $213 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,399 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,302 | Amount paid for insurance broker fees | 172 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 ) |
Policy contract number | LGS01417-17 |
Policy instance | 3 |
Insurance contract or identification number | LGS01417-17 | Number of Individuals Covered | 143 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $4,999 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $224,130 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 4999 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
Policy contract number | 52607 |
Policy instance | 1 |
Insurance contract or identification number | 52607 | Number of Individuals Covered | 134 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,931 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0579300 |
Policy instance | 6 |
Insurance contract or identification number | R0579300 | Number of Individuals Covered | 146 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $6,886 | Total amount of fees paid to insurance company | USD $781 | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVO | Welfare Benefit Premiums Paid to Carrier | USD $33,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,823 | Amount paid for insurance broker fees | 630 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 99200261001 |
Policy instance | 2 |
Insurance contract or identification number | 99200261001 | Number of Individuals Covered | 173 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,124 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,158 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,124 | Insurance broker organization code? | 3 |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865112 |
Policy instance | 4 |
Insurance contract or identification number | 0865112 | Number of Individuals Covered | 183 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $10,991 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL 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 Carrier | USD $39,596 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,685 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
Policy contract number | 52607 |
Policy instance | 3 |
Insurance contract or identification number | 52607 | Number of Individuals Covered | 170 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2015-09-30 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $347,919 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9920026 |
Policy instance | 2 |
Insurance contract or identification number | 9920026 | Number of Individuals Covered | 158 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $443 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $4,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $443 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
Policy contract number | 000700119 |
Policy instance | 1 |
Insurance contract or identification number | 000700119 | Number of Individuals Covered | 187 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2015-09-30 | Total amount of commissions paid to insurance broker | USD $465 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $3,742 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 465 | Additional information about fees paid to insurance broker | CLAIMS ADMINISTRATOR | Insurance broker organization code? | 5 | Insurance broker name | DELTA DENTAL OF VIRGINIA |
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UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
Policy contract number | 0HHU OHHV OZID |
Policy instance | 1 |
Insurance contract or identification number | 0HHU OHHV OZID | Number of Individuals Covered | 132 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $78 | Total amount of fees paid to insurance company | USD $12,649 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $552,083 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 6473 | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $78 | Insurance broker name | JAMES A SCOTT & SON INC |
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HEALTHKEEPERS, INC (National Association of Insurance Commissioners NAIC id number: 95169 ) |
Policy contract number | 52607 |
Policy instance | 2 |
Insurance contract or identification number | 52607 | Number of Individuals Covered | 170 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $41,565 | Total amount of fees paid to insurance company | USD $24,956 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $355,037 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $41,565 | Amount paid for insurance broker fees | 23093 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
Policy contract number | 000100510 |
Policy instance | 3 |
Insurance contract or identification number | 000100510 | Number of Individuals Covered | 187 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $2,305 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $28,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,724 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865112 |
Policy instance | 4 |
Insurance contract or identification number | 0865112 | Number of Individuals Covered | 183 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $14,934 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 Carrier | USD $79,291 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,685 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 9920026 |
Policy instance | 6 |
Insurance contract or identification number | 9920026 | Number of Individuals Covered | 158 | Insurance policy start date | 2014-10-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $443 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $4,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $443 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 443025 |
Policy instance | 5 |
Insurance contract or identification number | 443025 | Number of Individuals Covered | 99 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2014-09-30 | Total amount of commissions paid to insurance broker | USD $553 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $5,494 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $278 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A SCOTT & SON INC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0865112 |
Policy instance | 3 |
Insurance contract or identification number | 0865112 | Number of Individuals Covered | 186 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & 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 Carrier | USD $76,648 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
Policy contract number | 000100510 |
Policy instance | 2 |
Insurance contract or identification number | 000100510 | Number of Individuals Covered | 157 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $4,279 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $46,675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,279 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFOORD FINANCIAL SERVICES INC |
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UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
Policy contract number | 0HHU OHHV OZID |
Policy instance | 1 |
Insurance contract or identification number | 0HHU OHHV OZID | Number of Individuals Covered | 167 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $78 | Total amount of fees paid to insurance company | USD $21,805 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $960,585 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $78 | Amount paid for insurance broker fees | 21805 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFOORD BENEFIT SERVICES |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 443025 |
Policy instance | 4 |
Insurance contract or identification number | 443025 | Number of Individuals Covered | 96 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $914 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | 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 Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $9,970 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $914 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFOORD FINANCIAL SVCS INC |
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COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
Policy contract number | 9071479955 |
Policy instance | 2 |
Insurance contract or identification number | 9071479955 | Number of Individuals Covered | 172 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $6,364 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $54,660 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,364 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | JAMES A. SCOTT & SON, INC. |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5346644 |
Policy instance | 3 |
Insurance contract or identification number | 5346644 | Number of Individuals Covered | 156 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $6,241 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,393 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,598 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFOORD FINANCIAL SERVICES |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 443025 |
Policy instance | 4 |
Insurance contract or identification number | 443025 | Number of Individuals Covered | 86 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $960 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,862 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $584 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFOORD FINANCIAL SERVICES INC. |
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UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
Policy contract number | 0HHU 0HHV 0ZID |
Policy instance | 1 |
Insurance contract or identification number | 0HHU 0HHV 0ZID | Number of Individuals Covered | 142 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $18,446 | Total amount of fees paid to insurance company | USD $197 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $819,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,030 | Amount paid for insurance broker fees | 238 | Insurance broker organization code? | 3 | Insurance broker name | RUTHERFORD BENEFIT SERVICES |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 443025 |
Policy instance | 4 |
Insurance contract or identification number | 443025 | Number of Individuals Covered | 86 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $866 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,808 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
Policy contract number | 9071479955 |
Policy instance | 1 |
Insurance contract or identification number | 9071479955 | Number of Individuals Covered | 178 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $6,183 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $54,493 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5346644 |
Policy instance | 2 |
Insurance contract or identification number | 5346644 | Number of Individuals Covered | 156 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $6,261 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,390 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
Policy contract number | 0HHU |
Policy instance | 3 |
Insurance contract or identification number | 0HHU | Number of Individuals Covered | 145 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $18,221 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $809,816 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
Policy contract number | 9071479955 |
Policy instance | 1 |
Insurance contract or identification number | 9071479955 | Number of Individuals Covered | 175 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $5,930 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $51,190 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) |
Policy contract number | 0HHU |
Policy instance | 3 |
Insurance contract or identification number | 0HHU | Number of Individuals Covered | 160 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $16,304 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $657,846 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 443025 |
Policy instance | 4 |
Insurance contract or identification number | 443025 | Number of Individuals Covered | 83 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $791 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,907 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5346644 |
Policy instance | 2 |
Insurance contract or identification number | 5346644 | Number of Individuals Covered | 156 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $5,129 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,148 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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