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SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan NameSOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number 501

SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION. has sponsored the creation of one or more 401k plans.

Company Name:SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION.
Employer identification number (EIN):351118476
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01COLLEEN LAY COLLEEN LAY2019-01-16
5012016-07-01COLLEEN LAY
5012016-07-01 COLLEEN LAY2019-01-16

Plan Statistics for SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2022: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-0120
Total number of active participants reported on line 7a of the Form 55002022-07-0129
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-0129
Total participants2022-07-0129
2021: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-0130
Total number of active participants reported on line 7a of the Form 55002021-07-0127
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-0127
Total participants2021-07-0127
2020: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-0128
Total number of active participants reported on line 7a of the Form 55002020-07-0135
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0135
Total participants2020-07-0135
2019: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-0133
Total number of active participants reported on line 7a of the Form 55002019-07-0128
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-0128
Total participants2019-07-0128
2018: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0135
Total number of active participants reported on line 7a of the Form 55002018-07-0133
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-0133
Total participants2018-07-0133
2017: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0138
Total number of active participants reported on line 7a of the Form 55002017-07-010
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-0135
Total of all active and inactive participants2017-07-0135
Total participants2017-07-0135
2016: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-010
Total of all active and inactive participants2016-07-010
Total participants2016-07-010
Total number of active participants reported on line 7a of the Form 55002016-07-0138
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010

Financial Data on SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2023 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2023 401k financial data
Total income from all sources2023-06-30$1,201,168
Expenses. Total of all expenses incurred2023-06-30$1,201,168
Benefits paid (including direct rollovers)2023-06-30$892,549
Total plan assets at end of year2023-06-30$0
Total plan assets at beginning of year2023-06-30$0
Value of fidelity bond covering the plan2023-06-30$250,000
Total contributions received or receivable from participants2023-06-30$70,071
Expenses. Other expenses not covered elsewhere2023-06-30$278,854
Contributions received from other sources (not participants or employers)2023-06-30$17,999
Net income (gross income less expenses)2023-06-30$0
Net plan assets at end of year (total assets less liabilities)2023-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2023-06-30$0
Total contributions received or receivable from employer(s)2023-06-30$1,113,098
Expenses. Administrative service providers (salaries,fees and commissions)2023-06-30$29,765
2022 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-06-30$1,138,595
Expenses. Total of all expenses incurred2022-06-30$1,138,595
Benefits paid (including direct rollovers)2022-06-30$854,478
Total plan assets at end of year2022-06-30$0
Total plan assets at beginning of year2022-06-30$0
Value of fidelity bond covering the plan2022-06-30$250,000
Total contributions received or receivable from participants2022-06-30$64,789
Expenses. Other expenses not covered elsewhere2022-06-30$251,847
Net income (gross income less expenses)2022-06-30$0
Net plan assets at end of year (total assets less liabilities)2022-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$0
Total contributions received or receivable from employer(s)2022-06-30$1,073,806
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$32,270
2021 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2021 401k financial data
Total plan liabilities at beginning of year2021-06-30$0
Total income from all sources2021-06-30$677,084
Expenses. Total of all expenses incurred2021-06-30$629,743
Benefits paid (including direct rollovers)2021-06-30$373,865
Total plan assets at end of year2021-06-30$47,341
Total plan assets at beginning of year2021-06-30$0
Value of fidelity bond covering the plan2021-06-30$250,000
Total contributions received or receivable from participants2021-06-30$78,094
Expenses. Other expenses not covered elsewhere2021-06-30$223,974
Net income (gross income less expenses)2021-06-30$47,341
Net plan assets at end of year (total assets less liabilities)2021-06-30$47,341
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$0
Total contributions received or receivable from employer(s)2021-06-30$598,990
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$31,904
2020 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-06-30$705,059
Expenses. Total of all expenses incurred2020-06-30$705,059
Benefits paid (including direct rollovers)2020-06-30$464,221
Total plan assets at end of year2020-06-30$0
Total plan assets at beginning of year2020-06-30$0
Value of fidelity bond covering the plan2020-06-30$250,000
Total contributions received or receivable from participants2020-06-30$78,094
Expenses. Other expenses not covered elsewhere2020-06-30$208,489
Net income (gross income less expenses)2020-06-30$0
Net plan assets at end of year (total assets less liabilities)2020-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$0
Total contributions received or receivable from employer(s)2020-06-30$626,965
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$32,349
2018 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-06-30$657,141
Expenses. Total of all expenses incurred2018-06-30$657,141
Benefits paid (including direct rollovers)2018-06-30$421,806
Total plan assets at end of year2018-06-30$0
Total plan assets at beginning of year2018-06-30$0
Value of fidelity bond covering the plan2018-06-30$250,000
Total contributions received or receivable from participants2018-06-30$88,963
Expenses. Other expenses not covered elsewhere2018-06-30$203,589
Net income (gross income less expenses)2018-06-30$0
Net plan assets at end of year (total assets less liabilities)2018-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$0
Total contributions received or receivable from employer(s)2018-06-30$568,178
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$31,746
2017 : SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-06-30$456,467
Expenses. Total of all expenses incurred2017-06-30$456,467
Benefits paid (including direct rollovers)2017-06-30$297,294
Total plan assets at end of year2017-06-30$0
Total plan assets at beginning of year2017-06-30$0
Value of fidelity bond covering the plan2017-06-30$250,000
Total contributions received or receivable from participants2017-06-30$60,451
Expenses. Other expenses not covered elsewhere2017-06-30$128,051
Net income (gross income less expenses)2017-06-30$0
Net plan assets at end of year (total assets less liabilities)2017-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$0
Total contributions received or receivable from employer(s)2017-06-30$396,016
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$31,122

Form 5500 Responses for SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN

2022: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – TrustYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement - TrustYes
2021: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: SOUTHEASTERN INDIANA ECONOMIC OPPORTUNITY CORPORATION EMPLOYEE HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Submission has been amendedYes
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered29
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,912
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $17,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,912
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered29
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $422
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $8,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $422
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered29
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $11,574
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $231,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,574
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered27
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,496
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $23,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,496
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered27
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $468
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $9,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $468
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered27
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $9,935
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $198,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,935
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,562
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $23,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,562
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $502
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $9,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $502
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $8,513
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $171,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,513
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered28
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,532
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $23,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,532
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered28
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $491
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $9,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $491
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered28
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $7,833
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $156,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,833
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered33
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,102
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $28,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,102
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered33
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $535
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $10,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $535
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered33
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $8,176
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $163,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,176
Insurance broker organization code?3
MEDICAL BENEFITS MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 74322 )
Policy contract number10475
Policy instance 3
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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 $10,139
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 number10475
Policy instance 2
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
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 $27,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10475
Policy instance 1
Insurance contract or identification number10475
Number of Individuals Covered35
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $7,470
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $150,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,470
Insurance broker organization code?3
Insurance broker namePINNACLE ADVISORY GROUP OF INDIANA

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