HANCOCK-HARDIN-WYANDOT-PUTNAM COMMUNITY ACTION COMMISSION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN
401k plan membership statisitcs for HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 98 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 98 |
| 2021: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 114 |
| Total of all active and inactive participants | 2021-01-01 | 114 |
| 2020: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 69 |
| Total of all active and inactive participants | 2020-01-01 | 69 |
| Total participants | 2020-01-01 | 69 |
| 2019: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 74 |
| Total of all active and inactive participants | 2019-01-01 | 74 |
| Total participants | 2019-01-01 | 74 |
| 2018: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 66 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 66 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 66 |
| Number of participants with account balances | 2018-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 77 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 68 |
| Total of all active and inactive participants | 2017-01-01 | 68 |
| Total participants | 2017-01-01 | 68 |
| 2016: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 75 |
| Total of all active and inactive participants | 2016-01-01 | 75 |
| Total participants | 2016-01-01 | 75 |
| 2015: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 65 |
| Total of all active and inactive participants | 2015-01-01 | 65 |
| Total participants | 2015-01-01 | 65 |
| 2014: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 68 |
| Total of all active and inactive participants | 2014-01-01 | 68 |
| Total participants | 2014-01-01 | 68 |
| 2013: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 73 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 73 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 73 |
| Number of participants with account balances | 2013-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 77 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 77 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 77 |
| Number of participants with account balances | 2012-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 90 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 1 |
| Total of all active and inactive participants | 2011-01-01 | 91 |
| Total participants | 2011-01-01 | 91 |
| 2010: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 99 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 99 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 99 |
| Number of participants with account balances | 2010-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 74 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 73 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 73 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 73 |
| Number of participants with account balances | 2009-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2022 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $300,542 |
| Total plan liabilities at beginning of year | 2022-12-31 | $250,840 |
| Total income from all sources | 2022-12-31 | $2,374,067 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $2,339,846 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $1,962,555 |
| Total plan assets at end of year | 2022-12-31 | $903,292 |
| Total plan assets at beginning of year | 2022-12-31 | $819,369 |
| Value of fidelity bond covering the plan | 2022-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $212,125 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $1,349,139 |
| Other income received | 2022-12-31 | $997 |
| Net income (gross income less expenses) | 2022-12-31 | $34,221 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $602,750 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $568,529 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $811,806 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $377,291 |
| 2021 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $250,840 |
| Total plan liabilities at beginning of year | 2021-12-31 | $322,752 |
| Total income from all sources | 2021-12-31 | $1,096,779 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,274,554 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $890,879 |
| Total plan assets at end of year | 2021-12-31 | $819,369 |
| Total plan assets at beginning of year | 2021-12-31 | $1,069,056 |
| Value of fidelity bond covering the plan | 2021-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $201,285 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $84,640 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $53,019 |
| Net income (gross income less expenses) | 2021-12-31 | $-177,775 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $568,529 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $746,304 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $842,475 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $299,035 |
| 2020 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $322,752 |
| Total plan liabilities at beginning of year | 2020-12-31 | $128,109 |
| Total income from all sources | 2020-12-31 | $1,470,377 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $1,579,351 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $1,310,609 |
| Total plan assets at end of year | 2020-12-31 | $1,069,056 |
| Total plan assets at beginning of year | 2020-12-31 | $983,387 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $203,315 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $492,031 |
| Other income received | 2020-12-31 | $21,691 |
| Net income (gross income less expenses) | 2020-12-31 | $-108,974 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $746,304 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $855,278 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $753,340 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $268,742 |
| 2019 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $128,109 |
| Total plan liabilities at beginning of year | 2019-12-31 | $123,172 |
| Total income from all sources | 2019-12-31 | $834,048 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $1,000,129 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $732,180 |
| Total plan assets at end of year | 2019-12-31 | $983,387 |
| Total plan assets at beginning of year | 2019-12-31 | $1,144,531 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $158,477 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $86,632 |
| Other income received | 2019-12-31 | $3,506 |
| Net income (gross income less expenses) | 2019-12-31 | $-166,081 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $855,278 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,021,359 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $585,433 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $267,949 |
| 2018 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $123,172 |
| Total plan liabilities at beginning of year | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $790,825 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $774,720 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $564,360 |
| Total plan assets at end of year | 2018-12-31 | $1,144,531 |
| Total plan assets at beginning of year | 2018-12-31 | $1,005,254 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $172,527 |
| Other income received | 2018-12-31 | $3,614 |
| Net income (gross income less expenses) | 2018-12-31 | $16,105 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $1,021,359 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $1,005,254 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $614,684 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $210,360 |
| 2017 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $54,460 |
| Total income from all sources | 2017-12-31 | $771,703 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $761,040 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $548,685 |
| Total plan assets at end of year | 2017-12-31 | $1,005,254 |
| Total plan assets at beginning of year | 2017-12-31 | $1,049,051 |
| Value of fidelity bond covering the plan | 2017-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $97,713 |
| Other income received | 2017-12-31 | $2,621 |
| Net income (gross income less expenses) | 2017-12-31 | $10,663 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $1,005,254 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $994,591 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $671,369 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $212,355 |
| 2016 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $54,460 |
| Total plan liabilities at beginning of year | 2016-12-31 | $42,936 |
| Total income from all sources | 2016-12-31 | $1,290,418 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,199,754 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $993,450 |
| Total plan assets at end of year | 2016-12-31 | $1,049,051 |
| Total plan assets at beginning of year | 2016-12-31 | $946,863 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $137,584 |
| Other income received | 2016-12-31 | $351,822 |
| Net income (gross income less expenses) | 2016-12-31 | $90,664 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $994,591 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $903,927 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $801,012 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $206,304 |
| 2015 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2015 401k financial data |
|---|
| Transfers to/from the plan | 2015-12-31 | $0 |
| Total plan liabilities at end of year | 2015-12-31 | $42,936 |
| Total plan liabilities at beginning of year | 2015-12-31 | $48,714 |
| Total income from all sources | 2015-12-31 | $878,102 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $812,989 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $609,754 |
| Total plan assets at end of year | 2015-12-31 | $946,863 |
| Total plan assets at beginning of year | 2015-12-31 | $887,528 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $169,896 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $671 |
| Other income received | 2015-12-31 | $3,847 |
| Net income (gross income less expenses) | 2015-12-31 | $65,113 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $903,927 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $838,814 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $704,359 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $202,564 |
| 2014 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $48,714 |
| Total plan liabilities at beginning of year | 2014-12-31 | $73,741 |
| Total income from all sources | 2014-12-31 | $1,116,145 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $946,145 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $713,508 |
| Total plan assets at end of year | 2014-12-31 | $887,528 |
| Total plan assets at beginning of year | 2014-12-31 | $742,555 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $191,483 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $1,124 |
| Other income received | 2014-12-31 | $3,034 |
| Net income (gross income less expenses) | 2014-12-31 | $170,000 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $838,814 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $668,814 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $921,628 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $231,513 |
| 2013 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $73,741 |
| Total plan liabilities at beginning of year | 2013-12-31 | $90,574 |
| Total income from all sources | 2013-12-31 | $1,085,311 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $1,118,945 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $882,724 |
| Total plan assets at end of year | 2013-12-31 | $742,555 |
| Total plan assets at beginning of year | 2013-12-31 | $793,022 |
| Value of fidelity bond covering the plan | 2013-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $213,255 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $883 |
| Other income received | 2013-12-31 | $3,041 |
| Net income (gross income less expenses) | 2013-12-31 | $-33,634 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $668,814 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $702,448 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $869,015 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $235,338 |
| 2012 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $90,574 |
| Total plan liabilities at beginning of year | 2012-12-31 | $127,728 |
| Total income from all sources | 2012-12-31 | $1,100,090 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $952,094 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $702,333 |
| Total plan assets at end of year | 2012-12-31 | $793,022 |
| Total plan assets at beginning of year | 2012-12-31 | $682,180 |
| Value of fidelity bond covering the plan | 2012-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $215,783 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $16 |
| Other income received | 2012-12-31 | $4,022 |
| Net income (gross income less expenses) | 2012-12-31 | $147,996 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $702,448 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $554,452 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $880,285 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $249,745 |
| 2011 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $127,728 |
| Total plan liabilities at beginning of year | 2011-12-31 | $65,167 |
| Total income from all sources | 2011-12-31 | $1,184,887 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $1,456,202 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $1,425,599 |
| Total plan assets at end of year | 2011-12-31 | $682,180 |
| Total plan assets at beginning of year | 2011-12-31 | $890,934 |
| Value of fidelity bond covering the plan | 2011-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $237,342 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $30,603 |
| Other income received | 2011-12-31 | $8,382 |
| Net income (gross income less expenses) | 2011-12-31 | $-271,315 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $554,452 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $825,767 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $939,163 |
| 2010 : HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $65,167 |
| Total plan liabilities at beginning of year | 2010-12-31 | $131,483 |
| Total income from all sources | 2010-12-31 | $1,139,703 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $1,024,031 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $991,736 |
| Total plan assets at end of year | 2010-12-31 | $890,934 |
| Total plan assets at beginning of year | 2010-12-31 | $841,579 |
| Value of fidelity bond covering the plan | 2010-12-31 | $350,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $223,698 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $32,295 |
| Other income received | 2010-12-31 | $10,603 |
| Net income (gross income less expenses) | 2010-12-31 | $115,672 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $825,767 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $710,096 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $905,402 |
| 2022: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | Yes |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | Yes |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | Yes |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: HHWP COMMUNITY ACTION COMMISSION HEALTH & WELFARE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | Yes |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00620963 |
| Policy instance | 2 |
| Insurance contract or identification number | G 00620963 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $648 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,483 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $648 | | Insurance broker organization code? | 3 |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | SL305002902-221 |
| Policy instance | 1 |
| Insurance contract or identification number | SL305002902-221 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 | 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 $279,762 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G 00620963 |
| Policy instance | 2 |
| Insurance contract or identification number | G 00620963 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $684 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $684 | | Insurance broker organization code? | 3 |
|
| NATIONAL HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82538 ) |
| Policy contract number | L210465 |
| Policy instance | 1 |
| Insurance contract or identification number | L210465 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $75,589 | | 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 | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,309 | | Insurance broker organization code? | 3 |
|
| SPECTRUM UNDERWRITING MANAGERS, INC. (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-48-034 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-48-034 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $364 | | Total amount of fees paid to insurance company | USD $77,815 | | 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 | Yes | | 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 $178,744 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | PRECERTIFICATION SERVICE FEES |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40448 |
| Policy instance | 2 |
| Insurance contract or identification number | HCCLOT40448 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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? | 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 $12,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | 320513 |
| Policy instance | 3 |
| Insurance contract or identification number | 320513 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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? | 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 | 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 $8,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTRUM UNDERWRITING MANAGERS, INC. (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-48-034 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-48-034 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $357 | | Total amount of fees paid to insurance company | USD $81,052 | | 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 | Yes | | 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 $174,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $357 | | Amount paid for insurance broker fees | 59962 | | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATOR ADMIN FEES AND STOP-LOSS COMMISSIONS |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40448 |
| Policy instance | 2 |
| Insurance contract or identification number | HCCLOT40448 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 $12,181 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | 320513 |
| Policy instance | 3 |
| Insurance contract or identification number | 320513 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 | 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 $7,615 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 66 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | 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 $6,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40448 |
| Policy instance | 2 |
| Insurance contract or identification number | HCCLOT40448 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 $11,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTRUM UNDERWRITING MANAGERS, INC. (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-48-034 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-48-034 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $21,230 | | Total amount of fees paid to insurance company | USD $48,136 | | 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 | Yes | | 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 $130,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 410 | | Additional information about fees paid to insurance broker | ACCESS FEES | | Insurance broker organization code? | 0 |
|
| SPECTRUM UNDERWRITING MANAGERS, INC. (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-48-034 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-48-034 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | Yes | | 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 $128,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,210 | | Amount paid for insurance broker fees | 551 | | Additional information about fees paid to insurance broker | SALES COMMISSION AND FEES | | Insurance broker organization code? | 0 | | Insurance broker name | MUTUAL HEALTH SERVICES |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US-000442 |
| Policy instance | 4 |
| Insurance contract or identification number | US-000442 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | RESIDUAL FROM PRIOR YEAR | | 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 $208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3897 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-3897 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 $11,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 92 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | 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 $5,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 65 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | 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 $4,307 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,403 | | Insurance broker organization code? | 3 | | Insurance broker name | CONSUMER'S LIFE |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US-000442 |
| Policy instance | 1 |
| Insurance contract or identification number | US-000442 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | Yes | | 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 $123,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1100 | | Additional information about fees paid to insurance broker | PRE-CERT SERVICES FEES | | Insurance broker organization code? | 0 | | Commission paid to Insurance Broker | USD $12,403 | | Insurance broker name | SCHWENDEMAN AGENCY |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3897 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-3897 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 $12,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3897 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-3897 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 $12,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US-000442 |
| Policy instance | 1 |
| Insurance contract or identification number | US-000442 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $23,589 | | Total amount of fees paid to insurance company | USD $46,879 | | 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 | Yes | | 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 $144,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,661 | | Amount paid for insurance broker fees | 45731 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 5 | | Insurance broker name | SCHWENDEMAN AGENCY |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 68 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $4,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL INSURANCE/BARDON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 000 ) |
| Policy contract number | AN-1101013-3 |
| Policy instance | 1 |
| Insurance contract or identification number | AN-1101013-3 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $23,974 | | Total amount of fees paid to insurance company | USD $48,345 | | 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 | Yes | | 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 $147,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,550 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1185 | | Additional information about fees paid to insurance broker | PRECERT SERVICE FEES | | Insurance broker name | MUTUAL HEALTH SERVICES |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3897 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-3897 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 $11,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONSUMERS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62375 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 73 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 | 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 $4,388 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL INSURANCE/BARDON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 000 ) |
| Policy contract number | AN-1101013-2 |
| Policy instance | 1 |
| Insurance contract or identification number | AN-1101013-2 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,359 | | Total amount of fees paid to insurance company | USD $49,638 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $155,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,907 | | Amount paid for insurance broker fees | 48368 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 5 | | Insurance broker name | AMERICAN HEALTH HOLDING, INC |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-1132 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-1132 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 77 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,291 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 91 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN NATIONAL (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | AN-1101013 |
| Policy instance | 1 |
| Insurance contract or identification number | AN-1101013 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $26,074 | | Total amount of fees paid to insurance company | USD $30,603 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL EXCESS INSURANCE SERVICES (National Association of Insurance Commissioners NAIC id number: 52421 ) |
| Policy contract number | 949-0158 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-0158 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL EXCESS INSURANCE SERVICES (National Association of Insurance Commissioners NAIC id number: 52421 ) |
| Policy contract number | 280-8067 |
| Policy instance | 3 |
| Insurance contract or identification number | 280-8067 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,133 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | FMG20581-0001 |
| Policy instance | 2 |
| Insurance contract or identification number | FMG20581-0001 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,491 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 ) |
| Policy contract number | US000141 |
| Policy instance | 1 |
| Insurance contract or identification number | US000141 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $22,533 | | Total amount of fees paid to insurance company | USD $32,295 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $136,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,954 | | Amount paid for insurance broker fees | 26746 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | | Insurance broker organization code? | 5 | | Insurance broker name | STRATEGICE HEALTH CARE |
|
