JASPER LUMBER CO., INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2023 401k financial data |
|---|
| Total income from all sources | 2023-12-31 | $251,060 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $248,388 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $117,008 |
| Total plan assets at end of year | 2023-12-31 | $3,613 |
| Total plan assets at beginning of year | 2023-12-31 | $941 |
| Total contributions received or receivable from participants | 2023-12-31 | $108,407 |
| Net income (gross income less expenses) | 2023-12-31 | $2,672 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $3,613 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $941 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $142,653 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $131,380 |
| 2022 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $283,961 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $284,251 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $146,272 |
| Total plan assets at end of year | 2022-12-31 | $941 |
| Total plan assets at beginning of year | 2022-12-31 | $1,231 |
| Total contributions received or receivable from participants | 2022-12-31 | $101,768 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $125,726 |
| Net income (gross income less expenses) | 2022-12-31 | $-290 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $941 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,231 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $182,193 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $12,253 |
| 2021 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $345,964 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $332,844 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $191,369 |
| Total plan assets at end of year | 2021-12-31 | $1,231 |
| Total plan assets at beginning of year | 2021-12-31 | $-11,889 |
| Total contributions received or receivable from participants | 2021-12-31 | $99,643 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $130,169 |
| Net income (gross income less expenses) | 2021-12-31 | $13,120 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $1,231 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-11,889 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $246,321 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $11,306 |
| 2020 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $298,453 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $297,994 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $159,840 |
| Total plan assets at end of year | 2020-12-31 | $625 |
| Total plan assets at beginning of year | 2020-12-31 | $166 |
| Total contributions received or receivable from participants | 2020-12-31 | $89,579 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $126,355 |
| Net income (gross income less expenses) | 2020-12-31 | $459 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $625 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $166 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $208,874 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $11,799 |
| 2019 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $234,087 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $234,159 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $96,376 |
| Total plan assets at end of year | 2019-12-31 | $166 |
| Total plan assets at beginning of year | 2019-12-31 | $238 |
| Total contributions received or receivable from participants | 2019-12-31 | $93,869 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $124,611 |
| Net income (gross income less expenses) | 2019-12-31 | $-72 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $166 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $238 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $140,218 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $13,172 |
| 2018 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $268,553 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $268,636 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $112,612 |
| Total plan assets at end of year | 2018-12-31 | $238 |
| Total plan assets at beginning of year | 2018-12-31 | $321 |
| Total contributions received or receivable from participants | 2018-12-31 | $99,533 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $142,878 |
| Net income (gross income less expenses) | 2018-12-31 | $-83 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $238 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $321 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $169,020 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $13,146 |
| 2017 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $618,133 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $619,301 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $466,972 |
| Total plan assets at end of year | 2017-12-31 | $322 |
| Total plan assets at beginning of year | 2017-12-31 | $1,490 |
| Total contributions received or receivable from participants | 2017-12-31 | $105,789 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $138,694 |
| Net income (gross income less expenses) | 2017-12-31 | $-1,168 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $322 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $1,490 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $512,344 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $13,635 |
| 2016 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $299,321 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $298,125 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $155,776 |
| Total plan assets at end of year | 2016-12-31 | $1,490 |
| Total plan assets at beginning of year | 2016-12-31 | $294 |
| Total contributions received or receivable from participants | 2016-12-31 | $105,789 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $129,994 |
| Net income (gross income less expenses) | 2016-12-31 | $1,196 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $1,490 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $294 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $193,532 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $12,355 |
| 2015 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $332,464 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $332,811 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $175,033 |
| Total plan assets at end of year | 2015-12-31 | $294 |
| Total plan assets at beginning of year | 2015-12-31 | $641 |
| Total contributions received or receivable from participants | 2015-12-31 | $119,567 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $145,282 |
| Net income (gross income less expenses) | 2015-12-31 | $-347 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $294 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $641 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $212,897 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $12,496 |
| 2014 : JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $300,677 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $300,036 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $156,748 |
| Total plan assets at end of year | 2014-12-31 | $641 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Total contributions received or receivable from participants | 2014-12-31 | $143,288 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $130,175 |
| Net income (gross income less expenses) | 2014-12-31 | $641 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $641 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $157,389 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $13,113 |
| 2023: JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: JASPER LUMBER CO., INC. EMPLOYEE HEALTH 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 | No |
| 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: JASPER LUMBER CO., INC. EMPLOYEE HEALTH 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 | No |
| 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: JASPER LUMBER CO., INC. EMPLOYEE HEALTH 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 | No |
| 2020-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2019: JASPER LUMBER CO., INC. EMPLOYEE HEALTH 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 | No |
| 2019-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2018: JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 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 | No |
| 2018-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2017: JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 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 | No |
| 2017-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2016: JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 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 | No |
| 2016-01-01 | Plan funding arrangement – Insurance | 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 – General assets of the sponsor | Yes |
| 2015: JASPER LUMBER CO., INC. EMPLOYEE HEALTH 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 | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: JASPER LUMBER CO., INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | First time form 5500 has been submitted | Yes |
| 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 | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) |
| Policy contract number | 010-032115 |
| Policy instance | 4 |
| Insurance contract or identification number | 010-032115 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $423 | | 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 | 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 $4,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 ) |
| Policy contract number | 242128251020 |
| Policy instance | 3 |
| Insurance contract or identification number | 242128251020 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $748 | | 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 $16,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| Insurance contract or identification number | 10425 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 $3,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| Insurance contract or identification number | 10425 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $48 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | 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 $966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| Insurance contract or identification number | 10425 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $169 | | 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 $3,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| Insurance contract or identification number | 10425 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,349 | | 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 $102,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
| MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 ) |
| Policy contract number | 10425 |
| Policy instance | 2 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 10425 |
| Policy instance | 1 |
