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FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 401k Plan overview

Plan NameFARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN
Plan identification number 525

FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN Benefits

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

401k Sponsoring company profile

NATIONWIDE MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:NATIONWIDE MUTUAL INSURANCE COMPANY
Employer identification number (EIN):314177100
NAIC Classification:524140

Additional information about NATIONWIDE MUTUAL INSURANCE COMPANY

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1925-12-17
Company Identification Number: 119343
Legal Registered Office Address: -
-
-
United States of America (USA)
-

More information about NATIONWIDE MUTUAL INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5252017-01-01BRIAN BELL ROBERT WATTS2018-10-11
5252016-01-01JUDITH HARPER ROBERT WATTS2017-10-13
5252015-01-01KLAUS DIEM ROBERT WATTS2016-10-13
5252014-01-01TINA AMBROZY ROBERT WATTS2015-10-15
5252013-01-01BARBARA SCOTT KAREN MACKE2014-10-14
5252012-01-01DAN MOYER KAREN MACKE2013-10-10
5252011-01-01MARY BETH CADLE JOANNE MCGOLDRICK2012-10-08

Plan Statistics for FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN

401k plan membership statisitcs for FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN

Measure Date Value
2017: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01117
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
2016: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0196
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-01112
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01112
2015: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0192
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-0196
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0196
2014: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0185
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-0192
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0192
2013: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0168
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-0185
Total of all active and inactive participants2013-01-0185
2012: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0168
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-0167
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0167
2011: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0161
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-0168
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0168

Financial Data on FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN

Measure Date Value
2017 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$170,630
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$1,259
Total income from all sources2017-12-31$188,849
Expenses. Total of all expenses incurred2017-12-31$361,706
Benefits paid (including direct rollovers)2017-12-31$349,747
Total plan assets at end of year2017-12-31$0
Total plan assets at beginning of year2017-12-31$3,486
Value of fidelity bond covering the plan2017-12-31$100,000,000
Total contributions received or receivable from participants2017-12-31$166,581
Other income received2017-12-31$-8
Net income (gross income less expenses)2017-12-31$-172,857
Net plan assets at end of year (total assets less liabilities)2017-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,227
Total contributions received or receivable from employer(s)2017-12-31$22,276
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$11,959
2016 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$167,185
Total plan liabilities at end of year2016-12-31$1,259
Total plan liabilities at beginning of year2016-12-31$4,521
Total income from all sources2016-12-31$152,536
Expenses. Total of all expenses incurred2016-12-31$317,470
Benefits paid (including direct rollovers)2016-12-31$304,178
Total plan assets at end of year2016-12-31$3,486
Total plan assets at beginning of year2016-12-31$4,497
Value of fidelity bond covering the plan2016-12-31$100,000,000
Total contributions received or receivable from participants2016-12-31$153,788
Other income received2016-12-31$8
Net income (gross income less expenses)2016-12-31$-164,934
Net plan assets at end of year (total assets less liabilities)2016-12-31$2,227
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$-24
Total contributions received or receivable from employer(s)2016-12-31$-1,260
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$13,292
2015 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$213,567
Total plan liabilities at end of year2015-12-31$4,521
Total plan liabilities at beginning of year2015-12-31$4,050
Total income from all sources2015-12-31$123,437
Expenses. Total of all expenses incurred2015-12-31$337,114
Benefits paid (including direct rollovers)2015-12-31$323,674
Total plan assets at end of year2015-12-31$4,497
Total plan assets at beginning of year2015-12-31$4,136
Value of fidelity bond covering the plan2015-12-31$100,000,000
Total contributions received or receivable from participants2015-12-31$123,055
Other income received2015-12-31$369
Net income (gross income less expenses)2015-12-31$-213,677
Net plan assets at end of year (total assets less liabilities)2015-12-31$-24
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$86
Total contributions received or receivable from employer(s)2015-12-31$13
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$13,440
2014 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$166,172
Total plan liabilities at end of year2014-12-31$4,050
Total plan liabilities at beginning of year2014-12-31$4,493
Total income from all sources2014-12-31$113,120
Expenses. Total of all expenses incurred2014-12-31$279,886
Benefits paid (including direct rollovers)2014-12-31$267,611
Total plan assets at end of year2014-12-31$4,136
Total plan assets at beginning of year2014-12-31$5,173
Value of fidelity bond covering the plan2014-12-31$100,000,000
Total contributions received or receivable from participants2014-12-31$112,649
Other income received2014-12-31$471
Net income (gross income less expenses)2014-12-31$-166,766
Net plan assets at end of year (total assets less liabilities)2014-12-31$86
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$680
Total contributions received or receivable from employer(s)2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$12,275
2013 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$173,858
Total plan liabilities at end of year2013-12-31$4,493
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$117,017
Expenses. Total of all expenses incurred2013-12-31$316,835
Benefits paid (including direct rollovers)2013-12-31$284,280
Total plan assets at end of year2013-12-31$5,173
Total plan assets at beginning of year2013-12-31$26,640
Value of fidelity bond covering the plan2013-12-31$100,000,000
Total contributions received or receivable from participants2013-12-31$116,147
Expenses. Other expenses not covered elsewhere2013-12-31$22,914
Other income received2013-12-31$707
Net income (gross income less expenses)2013-12-31$-199,818
Net plan assets at end of year (total assets less liabilities)2013-12-31$680
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$26,640
Total contributions received or receivable from employer(s)2013-12-31$163
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$9,641
2012 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2012 401k financial data
Total plan liabilities at beginning of year2012-12-31$52,462
Total income from all sources2012-12-31$296,258
Expenses. Total of all expenses incurred2012-12-31$240,682
Benefits paid (including direct rollovers)2012-12-31$234,310
Total plan assets at end of year2012-12-31$26,640
Total plan assets at beginning of year2012-12-31$23,526
Value of fidelity bond covering the plan2012-12-31$100,000,000
Total contributions received or receivable from participants2012-12-31$88,858
Other income received2012-12-31$4
Net income (gross income less expenses)2012-12-31$55,576
Net plan assets at end of year (total assets less liabilities)2012-12-31$26,640
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$-28,936
Total contributions received or receivable from employer(s)2012-12-31$207,396
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$6,372
2011 : FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$52,462
Total income from all sources2011-12-31$484,942
Expenses. Total of all expenses incurred2011-12-31$513,878
Benefits paid (including direct rollovers)2011-12-31$461,089
Total plan assets at end of year2011-12-31$23,526
Value of fidelity bond covering the plan2011-12-31$100,000,000
Total contributions received or receivable from participants2011-12-31$76,861
Other income received2011-12-31$23,527
Net income (gross income less expenses)2011-12-31$-28,936
Net plan assets at end of year (total assets less liabilities)2011-12-31$-28,936
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$384,554
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$52,789

Form 5500 Responses for FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN

2017: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FARMLAND MUTUAL INSURANCE COMPANY RETIREE HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )
Policy contract numberH2001
Policy instance 2
Insurance contract or identification numberH2001
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $65,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 1
Insurance contract or identification numberSRSUP
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $112,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberH1509
Policy instance 2
Insurance contract or identification numberH1509
Number of Individuals Covered75
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $77,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 1
Insurance contract or identification numberSRSUP
Number of Individuals Covered37
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $88,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberH1509
Policy instance 1
Insurance contract or identification numberH1509
Number of Individuals Covered68
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $63,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 2
Insurance contract or identification numberSRSUP
Number of Individuals Covered38
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $82,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 2
Insurance contract or identification numberSRSUP
Number of Individuals Covered36
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $79,226
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberH1509
Policy instance 1
Insurance contract or identification numberH1509
Number of Individuals Covered62
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $61,898
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberSRSUP
Policy instance 2
Insurance contract or identification numberSRSUP
Number of Individuals Covered19
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $41,414
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberH1509
Policy instance 1
Insurance contract or identification numberH1509
Number of Individuals Covered38
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $43,546
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 73518 )
Policy contract number06604
Policy instance 1
Insurance contract or identification number06604
Number of Individuals Covered26
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $59,598
SHA, L.L.C. (National Association of Insurance Commissioners NAIC id number: 95138 )
Policy contract number483330
Policy instance 2
Insurance contract or identification number483330
Number of Individuals Covered2
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,459
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 73518 )
Policy contract number68182
Policy instance 3
Insurance contract or identification number68182
Number of Individuals Covered57
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $51,945

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