COOPER TIRE & RUBBER COMPANY LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA
401k plan membership statisitcs for COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA
| Measure | Date | Value |
|---|
| 2022: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,954 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,946 |
| 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 | 1,946 |
| 2021: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 2,289 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,954 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 1,954 |
| 2020: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 2,425 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,998 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 291 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 2,289 |
| 2019: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 2,347 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 2,102 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 323 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 2,425 |
| 2018: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 2,411 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 2,087 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 260 |
| Total of all active and inactive participants | 2018-01-01 | 2,347 |
| 2017: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 2,557 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 2,172 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 239 |
| Total of all active and inactive participants | 2017-01-01 | 2,411 |
| 2016: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 2,503 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 2,273 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 284 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 2,557 |
| 2015: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 2,457 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 2,193 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 310 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 2,503 |
| 2014: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 2,457 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 2,142 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 315 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 2,457 |
| 2013: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 2,575 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 2,146 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 311 |
| 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 | 2,457 |
| 2012: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 2,645 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 2,280 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 295 |
| 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 | 2,575 |
| 2011: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 2,598 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 2,338 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 307 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 2,645 |
| 2009: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 3,038 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 2,083 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 795 |
| 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 | 2,878 |
| 2022: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 benefit arrangement – Insurance | Yes |
| 2021: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 benefit arrangement – Insurance | Yes |
| 2020: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 benefit arrangement – Insurance | Yes |
| 2019: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 benefit arrangement – Insurance | Yes |
| 2018: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 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 benefit arrangement – Insurance | Yes |
| 2017: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 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 benefit arrangement – Insurance | Yes |
| 2016: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 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 – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 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 – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: COOPER TIRE & RUBBER DENTAL INSURANCE PLAN FINDLAY AND TEXARKANA 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 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 – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 4982 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,843 | | Total amount of fees paid to insurance company | USD $42,058 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | 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 $1,690,729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,843 | | Amount paid for insurance broker fees | 42058 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 2046 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $18,344 | | Total amount of fees paid to insurance company | USD $32,044 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | 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 $1,703,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,344 | | Amount paid for insurance broker fees | 32044 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 5075 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $14,378 | | Total amount of fees paid to insurance company | USD $13,743 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | 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 $1,583,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,378 | | Amount paid for insurance broker fees | 13743 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 5262 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $15,577 | | Total amount of fees paid to insurance company | USD $11,068 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | 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 $1,578,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,577 | | Amount paid for insurance broker fees | 11068 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 5250 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $15,366 | | Total amount of fees paid to insurance company | USD $6,412 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | 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 $1,539,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,366 | | Amount paid for insurance broker fees | 6412 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 165532U |
| Policy instance | 1 |
| Insurance contract or identification number | 165532U | | Number of Individuals Covered | 5598 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $13,146 | | 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 | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,570,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,146 | | Insurance broker organization code? | 3 | | Insurance broker name | HAVENS & CO INC. |
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