MESA FOODS LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MESA FOODS HEALTH AND WELFARE PLAN
Measure | Date | Value |
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2017: MESA FOODS HEALTH AND WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-02-01 | 290 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 0 |
Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
Total of all active and inactive participants | 2017-02-01 | 0 |
2016: MESA FOODS HEALTH AND WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-02-01 | 100 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 290 |
Number of retired or separated participants receiving benefits | 2016-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
Total of all active and inactive participants | 2016-02-01 | 290 |
2015: MESA FOODS HEALTH AND WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-02-01 | 101 |
Total of all active and inactive participants | 2015-02-01 | 0 |
Total participants | 2015-02-01 | 0 |
2014: MESA FOODS HEALTH AND WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-02-01 | 104 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 102 |
Total of all active and inactive participants | 2014-02-01 | 102 |
Total participants | 2014-02-01 | 102 |
2013: MESA FOODS HEALTH AND WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-02-01 | 207 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 207 |
Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
Total of all active and inactive participants | 2013-02-01 | 207 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-02-01 | 0 |
Total participants | 2013-02-01 | 207 |
2012: MESA FOODS HEALTH AND WELFARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-02-01 | 206 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 178 |
Number of retired or separated participants receiving benefits | 2012-02-01 | 2 |
Total of all active and inactive participants | 2012-02-01 | 180 |
Total participants | 2012-02-01 | 180 |
2011: MESA FOODS HEALTH AND WELFARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-02-01 | 194 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 160 |
Number of retired or separated participants receiving benefits | 2011-02-01 | 2 |
Total of all active and inactive participants | 2011-02-01 | 162 |
Total participants | 2011-02-01 | 162 |
2010: MESA FOODS HEALTH AND WELFARE PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-02-01 | 191 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 192 |
Number of retired or separated participants receiving benefits | 2010-02-01 | 2 |
Total of all active and inactive participants | 2010-02-01 | 194 |
Total participants | 2010-02-01 | 194 |
2009: MESA FOODS HEALTH AND WELFARE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-02-01 | 193 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 191 |
Number of retired or separated participants receiving benefits | 2009-02-01 | 2 |
Total of all active and inactive participants | 2009-02-01 | 193 |
Total participants | 2009-02-01 | 193 |
2017: MESA FOODS HEALTH AND WELFARE PLAN 2017 form 5500 responses |
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2017-02-01 | Type of plan entity | Single employer plan |
2017-02-01 | Submission has been amended | No |
2017-02-01 | This submission is the final filing | Yes |
2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2017-02-01 | Plan is a collectively bargained plan | No |
2017-02-01 | Plan funding arrangement – Insurance | Yes |
2017-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-02-01 | Plan benefit arrangement – Insurance | Yes |
2017-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: MESA FOODS HEALTH AND WELFARE PLAN 2016 form 5500 responses |
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2016-02-01 | Type of plan entity | Single employer plan |
2016-02-01 | Submission has been amended | No |
2016-02-01 | This submission is the final filing | No |
2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-02-01 | Plan is a collectively bargained plan | No |
2016-02-01 | Plan funding arrangement – Insurance | Yes |
2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-02-01 | Plan benefit arrangement – Insurance | Yes |
2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: MESA FOODS HEALTH AND WELFARE PLAN 2015 form 5500 responses |
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2015-02-01 | Type of plan entity | Single employer plan |
2015-02-01 | First time form 5500 has been submitted | Yes |
2015-02-01 | Submission has been amended | No |
2015-02-01 | This submission is the final filing | No |
2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-02-01 | Plan is a collectively bargained plan | No |
2015-02-01 | Plan funding arrangement – Insurance | Yes |
2015-02-01 | Plan benefit arrangement – Insurance | Yes |
2014: MESA FOODS HEALTH AND WELFARE PLAN 2014 form 5500 responses |
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2014-02-01 | Type of plan entity | Single employer plan |
2014-02-01 | First time form 5500 has been submitted | Yes |
2014-02-01 | Submission has been amended | No |
2014-02-01 | This submission is the final filing | No |
2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-02-01 | Plan is a collectively bargained plan | No |
2014-02-01 | Plan funding arrangement – Insurance | Yes |
2014-02-01 | Plan benefit arrangement – Insurance | Yes |
2013: MESA FOODS HEALTH AND WELFARE PLAN 2013 form 5500 responses |
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2013-02-01 | Type of plan entity | Single employer plan |
2013-02-01 | First time form 5500 has been submitted | Yes |
2013-02-01 | Submission has been amended | No |
2013-02-01 | This submission is the final filing | No |
2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-02-01 | Plan is a collectively bargained plan | No |
2013-02-01 | Plan funding arrangement – Insurance | Yes |
2013-02-01 | Plan benefit arrangement – Insurance | Yes |
2012: MESA FOODS HEALTH AND WELFARE PLAN 2012 form 5500 responses |
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2012-02-01 | Type of plan entity | Single employer plan |
2012-02-01 | First time form 5500 has been submitted | Yes |
2012-02-01 | Submission has been amended | No |
2012-02-01 | This submission is the final filing | No |
2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-02-01 | Plan is a collectively bargained plan | No |
2012-02-01 | Plan funding arrangement – Insurance | Yes |
2012-02-01 | Plan benefit arrangement – Insurance | Yes |
2011: MESA FOODS HEALTH AND WELFARE PLAN 2011 form 5500 responses |
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2011-02-01 | Type of plan entity | Single employer plan |
2011-02-01 | First time form 5500 has been submitted | Yes |
2011-02-01 | Submission has been amended | No |
2011-02-01 | This submission is the final filing | No |
2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-02-01 | Plan is a collectively bargained plan | No |
2011-02-01 | Plan funding arrangement – Insurance | Yes |
2011-02-01 | Plan benefit arrangement – Insurance | Yes |
2010: MESA FOODS HEALTH AND WELFARE PLAN 2010 form 5500 responses |
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2010-02-01 | Type of plan entity | Single employer plan |
2010-02-01 | First time form 5500 has been submitted | Yes |
2010-02-01 | Submission has been amended | No |
2010-02-01 | This submission is the final filing | No |
2010-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-02-01 | Plan is a collectively bargained plan | No |
2010-02-01 | Plan funding arrangement – Insurance | Yes |
2010-02-01 | Plan benefit arrangement – Insurance | Yes |
2009: MESA FOODS HEALTH AND WELFARE PLAN 2009 form 5500 responses |
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2009-02-01 | Type of plan entity | Single employer plan |
2009-02-01 | First time form 5500 has been submitted | Yes |
2009-02-01 | Submission has been amended | No |
2009-02-01 | This submission is the final filing | No |
2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-02-01 | Plan is a collectively bargained plan | No |
2009-02-01 | Plan funding arrangement – Insurance | Yes |
2009-02-01 | Plan benefit arrangement – Insurance | Yes |
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
Policy contract number | 685446/260376 |
Policy instance | 3 |
Insurance contract or identification number | 685446/260376 | Number of Individuals Covered | 119 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $46 | Total amount of fees paid to insurance company | USD $0 | 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 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 $670,785 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $46 | Insurance broker organization code? | 3 | Insurance broker name | CRYSTAL AND COMPANY |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VPS677728 |
Policy instance | 2 |
Insurance contract or identification number | VPS677728 | Number of Individuals Covered | 58 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,768 | Total amount of fees paid to insurance company | USD $0 | 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 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | 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 $24,836 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Commission paid to Insurance Broker | USD $2,768 | Insurance broker organization code? | 3 | Insurance broker name | CRYSTAL AND COMPANY |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 445131 |
Policy instance | 1 |
Insurance contract or identification number | 445131 | Number of Individuals Covered | 240 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,920 | 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 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 | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | 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 $72,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | Amount paid for insurance broker fees | 1920 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | CRYSTAL IBC LLC |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | 00195124 |
Policy instance | 4 |
Insurance contract or identification number | 00195124 | Number of Individuals Covered | 101 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | 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 | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $72,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $323 | Insurance broker name | ART HAUSER |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445131 |
Policy instance | 3 |
Insurance contract or identification number | 00445131 | Number of Individuals Covered | 226 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $9,439 | Total amount of fees paid to insurance company | USD $438 | 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 | Yes | Life Insurance Welfare Benefit | Yes | 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 $82,722 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,439 | Amount paid for insurance broker fees | 438 | Additional information about fees paid to insurance broker | FEE | Insurance broker name | ART HAUSER INSURANCE INC |
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HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | ETB129015 |
Policy instance | 2 |
Insurance contract or identification number | ETB129015 | Number of Individuals Covered | 10 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $105 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | 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 $750 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $105 | Insurance broker name | ART HAUSER INSURANCE INC |
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HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
Policy contract number | 685446 |
Policy instance | 1 |
Insurance contract or identification number | 685446 | Number of Individuals Covered | 101 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $29,714 | Total amount of fees paid to insurance company | USD $707,914 | 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 | 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 $707,914 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,714 | Amount paid for insurance broker fees | 3563 | Additional information about fees paid to insurance broker | BONUS | Insurance broker name | ART HAUSER INS INC |
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HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) |
Policy contract number | 685446 |
Policy instance | 1 |
Insurance contract or identification number | 685446 | Number of Individuals Covered | 102 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $31,911 | 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 $697,124 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,879 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445131 |
Policy instance | 2 |
Insurance contract or identification number | 00445131 | Number of Individuals Covered | 94 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $455,729 | Total amount of fees paid to insurance company | USD $57 | 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 | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | 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 $41,189 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,091 | Amount paid for insurance broker fees | 0 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 172 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | 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 | No | Long Term Disability Insurance Welfare Benefit | Yes | 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 $30,963 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,088 | Amount paid for insurance broker fees | 0 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 0748V5 |
Policy instance | 3 |
Insurance contract or identification number | 0748V5 | Number of Individuals Covered | 193 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $3,904 | 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 | 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 $3,904 | Commission paid to Insurance Broker | USD $3,904 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445131 |
Policy instance | 2 |
Insurance contract or identification number | 00445131 | Number of Individuals Covered | 25 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | 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 $1,428 | 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 | Amount paid for insurance broker fees | 0 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 00195124 |
Policy instance | 1 |
Insurance contract or identification number | 00195124 | Number of Individuals Covered | 207 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | 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 | Yes | 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 $677,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,803 | Amount paid for insurance broker fees | 0 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 0748V5 |
Policy instance | 2 |
Insurance contract or identification number | 0748V5 | Number of Individuals Covered | 181 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $3,646 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,646 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | 00195124 |
Policy instance | 3 |
Insurance contract or identification number | 00195124 | Total amount of commissions paid to insurance broker | USD $3,181 | Total amount of fees paid to insurance company | USD $0 | Life 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? | Yes | Commission paid to Insurance Broker | USD $3,181 | Amount paid for insurance broker fees | 0 | Insurance broker name | BROWN AND BROWN OF KENTUCKY |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 00195124 |
Policy instance | 1 |
Insurance contract or identification number | 00195124 | Number of Individuals Covered | 197 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $787,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,671 | Amount paid for insurance broker fees | 88 | Insurance broker name | BROWN AND BROWN OF KENTUCKY |
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ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
Policy contract number | 00195124 |
Policy instance | 1 |
Insurance contract or identification number | 00195124 | Number of Individuals Covered | 28 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $3,394 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $29,374 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 000009552 |
Policy instance | 2 |
Insurance contract or identification number | 000009552 | Number of Individuals Covered | 231 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $16,319 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $689,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 0745V5 |
Policy instance | 3 |
Insurance contract or identification number | 0745V5 | Number of Individuals Covered | 190 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $3,159 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,096 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
Policy contract number | 000009552 |
Policy instance | 3 |
Insurance contract or identification number | 000009552 | Number of Individuals Covered | 194 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $27,620 | Health 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 $27,620 | Insurance broker name | BROWN AND BROWN OF KENTUCKY INC |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 7013676A |
Policy instance | 1 |
Insurance contract or identification number | 7013676A | Number of Individuals Covered | 55 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $1,117 | Total amount of fees paid to insurance company | USD $355 | Temporary 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 $274 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 53 | Additional information about fees paid to insurance broker | MARKETING FEE | Insurance broker name | TOWERS PERRIN FORSTER & CROSBY INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00445131 |
Policy instance | 2 |
Insurance contract or identification number | 00445131 | Number of Individuals Covered | 146 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $7,993 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | 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 $7,993 | Insurance broker name | BROWN & BROWN OF KENTUCKY |
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