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KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 401k Plan overview

Plan NameKATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN
Plan identification number 515

KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover

401k Sponsoring company profile

KATHERINE SHAW BETHEA HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:KATHERINE SHAW BETHEA HOSPITAL
Employer identification number (EIN):361000540
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152022-01-01
5152021-01-01
5152020-01-01
5152019-01-01
5152018-01-01
5152017-01-01SUZANNE RAVLIN
5152016-01-01SUZANNE RAVLIN
5152016-01-01
5152015-01-01SUZANNE RAVLIN
5152014-01-01SUZANNE RAVLIN
5152013-01-01SUZANNE RAVLIN
5152012-01-01SUZANNE RAVLIN SUZANNE RAVLIN2013-10-15
5152011-01-01SUZANNE RAVLIN
5152009-01-01 DEBRA DIDIER2010-07-21
5152009-01-01DEBRA DIDIER
5152008-01-01 DEBRA DIDIER2010-02-23
5152007-01-01 DEBRA DIDIER2010-02-23
5152006-01-01 DEBRA DIDIER2010-02-23
5152005-01-01 DEBRA DIDIER2010-02-23
5152004-01-01 DEBRA DIDIER2010-02-23
5152003-01-01 DEBRA DIDIER2010-02-23
5152002-01-01 DEBRA DIDIER2010-02-23
5152001-01-01 DEBRA DIDIER2010-02-23
5152000-01-01 DEBRA DIDIER2010-02-23

Plan Statistics for KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

401k plan membership statisitcs for KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

Measure Date Value
2022: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01353
Total number of active participants reported on line 7a of the Form 55002022-01-01353
Total of all active and inactive participants2022-01-01353
Total participants2022-01-01353
2021: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01291
Total number of active participants reported on line 7a of the Form 55002021-01-01291
Total of all active and inactive participants2021-01-01291
Total participants2021-01-01291
2020: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01303
Total number of active participants reported on line 7a of the Form 55002020-01-01303
Total of all active and inactive participants2020-01-01303
Total participants2020-01-01303
2019: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01320
Total number of active participants reported on line 7a of the Form 55002019-01-01320
Total of all active and inactive participants2019-01-01320
Total participants2019-01-01320
2018: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01325
Total number of active participants reported on line 7a of the Form 55002018-01-01325
Total of all active and inactive participants2018-01-01325
Total participants2018-01-01325
2017: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01331
Total number of active participants reported on line 7a of the Form 55002017-01-010
Total of all active and inactive participants2017-01-010
Total participants2017-01-010
2016: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01100
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
Total participants2016-01-010
2015: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0199
Total number of active participants reported on line 7a of the Form 55002015-01-0199
Total of all active and inactive participants2015-01-0199
Total participants2015-01-0199
2014: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01100
Total of all active and inactive participants2014-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-010
2013: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01102
Total number of active participants reported on line 7a of the Form 55002013-01-01102
Total of all active and inactive participants2013-01-01102
Total participants2013-01-01102
2012: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01105
Total number of active participants reported on line 7a of the Form 55002012-01-01105
Total of all active and inactive participants2012-01-01105
Total participants2012-01-01105
2011: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01103
Total number of active participants reported on line 7a of the Form 55002011-01-01103
Total of all active and inactive participants2011-01-01103
Total participants2011-01-01103
2009: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01452
Total number of active participants reported on line 7a of the Form 55002009-01-01474
Total of all active and inactive participants2009-01-01474
Total participants2009-01-01474
2008: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01470
Total number of active participants reported on line 7a of the Form 55002008-01-01452
Total of all active and inactive participants2008-01-01452
Total participants2008-01-01452
2007: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01486
Total number of active participants reported on line 7a of the Form 55002007-01-01470
Total of all active and inactive participants2007-01-01470
Total participants2007-01-01470
2006: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01474
Total number of active participants reported on line 7a of the Form 55002006-01-01486
Total of all active and inactive participants2006-01-01486
Total participants2006-01-01486
2005: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01500
Total number of active participants reported on line 7a of the Form 55002005-01-01474
Total of all active and inactive participants2005-01-01474
Total participants2005-01-01474
2004: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01428
Total number of active participants reported on line 7a of the Form 55002004-01-01500
Total of all active and inactive participants2004-01-01500
Total participants2004-01-01500
2003: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2003 401k membership
Total participants, beginning-of-year2003-01-01430
Total number of active participants reported on line 7a of the Form 55002003-01-01428
Total of all active and inactive participants2003-01-01428
Total participants2003-01-01428
2002: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2002 401k membership
Total participants, beginning-of-year2002-01-01419
Total number of active participants reported on line 7a of the Form 55002002-01-01430
Total of all active and inactive participants2002-01-01430
Total participants2002-01-01430
2001: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2001 401k membership
Total participants, beginning-of-year2001-01-01408
Total number of active participants reported on line 7a of the Form 55002001-01-01419
Total of all active and inactive participants2001-01-01419
Total participants2001-01-01419
2000: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2000 401k membership
Total participants, beginning-of-year2000-01-01370
Total number of active participants reported on line 7a of the Form 55002000-01-01408
Total of all active and inactive participants2000-01-01408
Total participants2000-01-01408

Form 5500 Responses for KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

2022: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – InsuranceYes
2005: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedNo
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – InsuranceYes
2005-01-01Plan benefit arrangement – InsuranceYes
2004: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedNo
2004-01-01This submission is the final filingNo
2004-01-01This return/report is a short plan year return/report (less than 12 months)No
2004-01-01Plan is a collectively bargained planNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – InsuranceYes
2003: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01Submission has been amendedNo
2003-01-01This submission is the final filingNo
2003-01-01This return/report is a short plan year return/report (less than 12 months)No
2003-01-01Plan is a collectively bargained planNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan benefit arrangement – InsuranceYes
2002: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2002 form 5500 responses
2002-01-01Type of plan entitySingle employer plan
2002-01-01Submission has been amendedNo
2002-01-01This submission is the final filingNo
2002-01-01This return/report is a short plan year return/report (less than 12 months)No
2002-01-01Plan is a collectively bargained planNo
2002-01-01Plan funding arrangement – InsuranceYes
2002-01-01Plan benefit arrangement – InsuranceYes
2001: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2001 form 5500 responses
2001-01-01Type of plan entitySingle employer plan
2001-01-01Submission has been amendedNo
2001-01-01This submission is the final filingNo
2001-01-01This return/report is a short plan year return/report (less than 12 months)No
2001-01-01Plan is a collectively bargained planNo
2001-01-01Plan funding arrangement – InsuranceYes
2001-01-01Plan benefit arrangement – InsuranceYes
2000: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2000 form 5500 responses
2000-01-01Type of plan entitySingle employer plan
2000-01-01First time form 5500 has been submittedYes
2000-01-01Submission has been amendedNo
2000-01-01This submission is the final filingNo
2000-01-01This return/report is a short plan year return/report (less than 12 months)No
2000-01-01Plan is a collectively bargained planNo
2000-01-01Plan funding arrangement – InsuranceYes
2000-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 1
Insurance contract or identification number3
Number of Individuals Covered353
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,133
Total amount of fees paid to insurance companyUSD $4,403
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,133
Amount paid for insurance broker fees4403
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 1
Insurance contract or identification number3
Number of Individuals Covered291
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,676
Total amount of fees paid to insurance companyUSD $3,396
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,676
Amount paid for insurance broker fees3396
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 1
Insurance contract or identification number3
Number of Individuals Covered303
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,321
Total amount of fees paid to insurance companyUSD $14,687
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,321
Amount paid for insurance broker fees11321
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number
Policy instance 1
Number of Individuals Covered320
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3578
Commission paid to Insurance BrokerUSD $11,220
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 1
Insurance contract or identification number3
Number of Individuals Covered35
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $11,927
Total amount of fees paid to insurance companyUSD $14,937
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Amount paid for insurance broker fees11927
Commission paid to Insurance BrokerUSD $0
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number3
Policy instance 1
Insurance contract or identification number3
Number of Individuals Covered331
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $13,381
Total amount of fees paid to insurance companyUSD $16,558
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 BenefitYes
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
Commission paid to Insurance BrokerUSD $13,381
Amount paid for insurance broker fees16558
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker nameGALLAGHER BENEFIT SERVICE INC

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