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THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 401k Plan overview

Plan NameTHE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN
Plan identification number 501

THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN Benefits

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

401k Sponsoring company profile

THE NORTH AMERICAN COAL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:THE NORTH AMERICAN COAL CORPORATION
Employer identification number (EIN):341554846
NAIC Classification:212110
NAIC Description: Coal Mining

Additional information about THE NORTH AMERICAN COAL CORPORATION

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1989-04-17
Company Identification Number: 0007976306
Legal Registered Office Address: 5340 LEGACY DR STE 300

PLANO
United States of America (USA)
75024

More information about THE NORTH AMERICAN COAL CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01SARAH FRY2019-10-01
5012017-01-01SARAH FRY SARAH FRY2018-10-15
5012016-01-01SARAH FRY SARAH FRY2017-10-16
5012015-01-01DONALD GRISCHOW DONALD GRISCHOW2016-07-19
5012014-01-01DONALD GRISCHOW DONALD GRISCHOW2015-09-10
5012013-01-01DONALD GRISCHOW DONALD GRISCHOW2014-07-30
5012012-01-01DONALD GRISCHOW DONALD GRISCHOW2013-09-26
5012011-01-01DONALD GRISCHOW
5012010-01-01DONALD GRISCHOW
5012009-01-01K. DONALD GRISCHOW

Plan Statistics for THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN

401k plan membership statisitcs for THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN

Measure Date Value
2022: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,481
Total number of active participants reported on line 7a of the Form 55002022-01-011,457
Number of retired or separated participants receiving benefits2022-01-0144
Total of all active and inactive participants2022-01-011,501
Total participants2022-01-011,501
2021: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,859
Total number of active participants reported on line 7a of the Form 55002021-01-011,434
Number of retired or separated participants receiving benefits2021-01-0125
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-011,459
Total participants2021-01-011,459
2020: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-012,060
Total number of active participants reported on line 7a of the Form 55002020-01-011,815
Number of retired or separated participants receiving benefits2020-01-01276
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-012,091
2019: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,913
Total number of active participants reported on line 7a of the Form 55002019-01-011,901
Number of retired or separated participants receiving benefits2019-01-0112
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,913
2018: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,092
Total number of active participants reported on line 7a of the Form 55002018-01-011,904
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,904
2017: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,000
Total number of active participants reported on line 7a of the Form 55002017-01-012,092
Total of all active and inactive participants2017-01-012,092
Total participants2017-01-012,092
2016: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,906
Total number of active participants reported on line 7a of the Form 55002016-01-012,000
Total of all active and inactive participants2016-01-012,000
2015: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,891
Total number of active participants reported on line 7a of the Form 55002015-01-011,906
Total of all active and inactive participants2015-01-011,906
2014: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,780
Total number of active participants reported on line 7a of the Form 55002014-01-011,848
Number of retired or separated participants receiving benefits2014-01-0143
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,891
2013: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,540
Total number of active participants reported on line 7a of the Form 55002013-01-011,750
Number of retired or separated participants receiving benefits2013-01-0130
Total of all active and inactive participants2013-01-011,780
2012: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,420
Total number of active participants reported on line 7a of the Form 55002012-01-011,512
Number of retired or separated participants receiving benefits2012-01-0128
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011,540
2011: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,152
Total number of active participants reported on line 7a of the Form 55002011-01-011,389
Number of retired or separated participants receiving benefits2011-01-0131
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-011,420
2010: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,075
Total number of active participants reported on line 7a of the Form 55002010-01-011,116
Number of retired or separated participants receiving benefits2010-01-0136
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,152
2009: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,053
Total number of active participants reported on line 7a of the Form 55002009-01-011,058
Number of retired or separated participants receiving benefits2009-01-0117
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,075

Form 5500 Responses for THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN

2022: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 filingNo
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 – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL 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 – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
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 – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: THE NORTH AMERICAN COAL CORPORATION ACTIVE MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number04197A
Policy instance 1
Insurance contract or identification number04197A
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,286
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 $22,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,286
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES OF OREGON
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number04197A
Policy instance 2
Insurance contract or identification number04197A
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,290
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 $12,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,290
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES OF OREGON
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number04197A
Policy instance 1
Insurance contract or identification number04197A
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $858
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 $8,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $858
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES OF OREGON
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number04197A
Policy instance 1
Insurance contract or identification number04197A
Number of Individuals Covered2
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,686
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 $96,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,686
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS. SERVICES OF OREGON
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number04197A
Policy instance 1
Insurance contract or identification number04197A
Number of Individuals Covered4
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,787
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 $77,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number04197A
Policy instance 1
Insurance contract or identification number04197A
Number of Individuals Covered2
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $5,430
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 BenefitYes
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 $54,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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