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PLAN A HEALTH CARE PLAN 401k Plan overview

Plan NamePLAN A HEALTH CARE PLAN
Plan identification number 501

PLAN A HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

COMMUNITY LIVING OPTIONS, INC. has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY LIVING OPTIONS, INC.
Employer identification number (EIN):371079626
NAIC Classification:561210
NAIC Description:Facilities Support Services

Additional information about COMMUNITY LIVING OPTIONS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1993-01-28
Company Identification Number: P93000008427
Legal Registered Office Address: 6719 COLLINS SPRING COVE

RIVERVIEW

33569

More information about COMMUNITY LIVING OPTIONS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PLAN A HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01RONALD J. WILSON2023-08-15
5012020-11-01RONALD J. WILSON2022-08-09
5012019-11-01RONALD J. WILSON2021-08-04
5012019-11-01RONALD J. WILSON2021-08-04

Plan Statistics for PLAN A HEALTH CARE PLAN

401k plan membership statisitcs for PLAN A HEALTH CARE PLAN

Measure Date Value
2021: PLAN A HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-011,362
Total number of active participants reported on line 7a of the Form 55002021-11-011,353
Number of retired or separated participants receiving benefits2021-11-012
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-011,355
2020: PLAN A HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-011,517
Total number of active participants reported on line 7a of the Form 55002020-11-011,380
Number of retired or separated participants receiving benefits2020-11-013
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-011,383
2019: PLAN A HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-011,716
Total number of active participants reported on line 7a of the Form 55002019-11-011,507
Number of retired or separated participants receiving benefits2019-11-0110
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-011,517

Financial Data on PLAN A HEALTH CARE PLAN

Measure Date Value
2022 : PLAN A HEALTH CARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-10-31$1,083,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-10-31$901,485
Total income from all sources (including contributions)2022-10-31$7,741,833
Total loss/gain on sale of assets2022-10-31$0
Total of all expenses incurred2022-10-31$8,383,884
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-10-31$7,793,060
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-10-31$7,788,284
Value of total assets at end of year2022-10-31$4,134,120
Value of total assets at beginning of year2022-10-31$4,594,498
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-10-31$590,824
Total interest from all sources2022-10-31$13,970
Total dividends received (eg from common stock, registered investment company shares)2022-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-10-31No
Administrative expenses professional fees incurred2022-10-31$590,824
Was this plan covered by a fidelity bond2022-10-31Yes
Value of fidelity bond cover2022-10-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-10-31No
Contributions received from participants2022-10-31$2,497,727
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-10-31$141,932
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-10-31$171,247
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-10-31$27,308
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-10-31$134,726
Total non interest bearing cash at end of year2022-10-31$2,188,351
Total non interest bearing cash at beginning of year2022-10-31$2,549,901
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-10-31No
Value of net income/loss2022-10-31$-642,051
Value of net assets at end of year (total assets less liabilities)2022-10-31$3,050,962
Value of net assets at beginning of year (total assets less liabilities)2022-10-31$3,693,013
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-10-31No
Were any leases to which the plan was party in default or uncollectible2022-10-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-10-31$298,497
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-10-31$346,797
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-10-31$1,502,575
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-10-31$1,510,838
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-10-31$1,510,838
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-10-31$13,970
Expenses. Payments to insurance carriers foe the provision of benefits2022-10-31$879,922
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-10-31$-60,421
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-10-31Yes
Was there a failure to transmit to the plan any participant contributions2022-10-31No
Has the plan failed to provide any benefit when due under the plan2022-10-31No
Contributions received in cash from employer2022-10-31$5,290,557
Employer contributions (assets) at end of year2022-10-31$2,765
Employer contributions (assets) at beginning of year2022-10-31$15,715
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-10-31$6,913,138
Liabilities. Value of benefit claims payable at end of year2022-10-31$1,055,850
Liabilities. Value of benefit claims payable at beginning of year2022-10-31$766,759
Did the plan have assets held for investment2022-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-10-31No
Opinion of an independent qualified public accountant for this plan2022-10-31Unqualified
Accountancy firm name2022-10-31RSM US LLP
Accountancy firm EIN2022-10-31420714325
2021 : PLAN A HEALTH CARE PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-10-31$901,485
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-10-31$1,074,089
Total income from all sources (including contributions)2021-10-31$9,153,971
Total loss/gain on sale of assets2021-10-31$0
Total of all expenses incurred2021-10-31$8,705,951
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-10-31$8,098,416
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-10-31$9,147,731
Value of total assets at end of year2021-10-31$4,594,498
Value of total assets at beginning of year2021-10-31$4,319,082
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-10-31$607,535
Total interest from all sources2021-10-31$15,749
Total dividends received (eg from common stock, registered investment company shares)2021-10-31$-25,260
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-10-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-10-31$-25,260
Administrative expenses professional fees incurred2021-10-31$607,535
Was this plan covered by a fidelity bond2021-10-31Yes
Value of fidelity bond cover2021-10-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-10-31No
Contributions received from participants2021-10-31$2,881,629
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-10-31$171,247
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-10-31$390,091
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-10-31$134,726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-10-31$146,268
Total non interest bearing cash at end of year2021-10-31$2,549,901
Total non interest bearing cash at beginning of year2021-10-31$2,048,853
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Value of net income/loss2021-10-31$448,020
Value of net assets at end of year (total assets less liabilities)2021-10-31$3,693,013
Value of net assets at beginning of year (total assets less liabilities)2021-10-31$3,244,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-10-31No
Were any leases to which the plan was party in default or uncollectible2021-10-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-10-31$346,797
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-10-31$351,821
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-10-31$1,510,838
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-10-31$1,512,602
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-10-31$1,512,602
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-10-31$15,749
Expenses. Payments to insurance carriers foe the provision of benefits2021-10-31$1,038,537
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-10-31$15,751
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-10-31Yes
Was there a failure to transmit to the plan any participant contributions2021-10-31No
Has the plan failed to provide any benefit when due under the plan2021-10-31No
Contributions received in cash from employer2021-10-31$6,266,102
Employer contributions (assets) at end of year2021-10-31$15,715
Employer contributions (assets) at beginning of year2021-10-31$15,715
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-10-31$7,059,879
Liabilities. Value of benefit claims payable at end of year2021-10-31$766,759
Liabilities. Value of benefit claims payable at beginning of year2021-10-31$927,821
Did the plan have assets held for investment2021-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-10-31No
Opinion of an independent qualified public accountant for this plan2021-10-31Unqualified
Accountancy firm name2021-10-31RSM US LLP
Accountancy firm EIN2021-10-31420714325
2020 : PLAN A HEALTH CARE PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$1,074,089
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$1,372,766
Total income from all sources (including contributions)2020-10-31$10,602,086
Total loss/gain on sale of assets2020-10-31$0
Total of all expenses incurred2020-10-31$10,866,895
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-10-31$10,309,402
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-10-31$10,560,336
Value of total assets at end of year2020-10-31$4,319,082
Value of total assets at beginning of year2020-10-31$4,882,568
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-10-31$557,493
Total interest from all sources2020-10-31$20,350
Total dividends received (eg from common stock, registered investment company shares)2020-10-31$6,950
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-10-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-10-31$6,950
Administrative expenses professional fees incurred2020-10-31$557,493
Was this plan covered by a fidelity bond2020-10-31Yes
Value of fidelity bond cover2020-10-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-10-31No
Contributions received from participants2020-10-31$3,316,221
Participant contributions at end of year2020-10-31$0
Participant contributions at beginning of year2020-10-31$242,992
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-10-31$390,091
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-10-31$210,880
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-10-31$146,268
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-10-31$127,608
Total non interest bearing cash at end of year2020-10-31$2,048,853
Total non interest bearing cash at beginning of year2020-10-31$1,960,770
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Value of net income/loss2020-10-31$-264,809
Value of net assets at end of year (total assets less liabilities)2020-10-31$3,244,993
Value of net assets at beginning of year (total assets less liabilities)2020-10-31$3,509,802
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-10-31No
Were any leases to which the plan was party in default or uncollectible2020-10-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-10-31$351,821
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-10-31$338,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-10-31$1,512,602
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-10-31$1,509,021
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-10-31$1,509,021
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-10-31$20,350
Expenses. Payments to insurance carriers foe the provision of benefits2020-10-31$1,265,501
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-10-31$14,450
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-10-31Yes
Was there a failure to transmit to the plan any participant contributions2020-10-31No
Has the plan failed to provide any benefit when due under the plan2020-10-31No
Contributions received in cash from employer2020-10-31$7,244,115
Employer contributions (assets) at end of year2020-10-31$15,715
Employer contributions (assets) at beginning of year2020-10-31$620,703
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-10-31$9,043,901
Liabilities. Value of benefit claims payable at end of year2020-10-31$927,821
Liabilities. Value of benefit claims payable at beginning of year2020-10-31$1,245,158
Did the plan have assets held for investment2020-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-10-31No
Opinion of an independent qualified public accountant for this plan2020-10-31Unqualified
Accountancy firm name2020-10-31RSM US LLP
Accountancy firm EIN2020-10-31420714325

Form 5500 Responses for PLAN A HEALTH CARE PLAN

2021: PLAN A HEALTH CARE PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Submission has been amendedNo
2021-11-01This submission is the final filingNo
2021-11-01This return/report is a short plan year return/report (less than 12 months)No
2021-11-01Plan is a collectively bargained planNo
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – TrustYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement - TrustYes
2020: PLAN A HEALTH CARE PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Submission has been amendedNo
2020-11-01This submission is the final filingNo
2020-11-01This return/report is a short plan year return/report (less than 12 months)No
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: PLAN A HEALTH CARE PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedYes
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-015142-00
Policy instance 1
Insurance contract or identification number01-015142-00
Number of Individuals Covered1028
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $8,192
Total amount of fees paid to insurance companyUSD $2,049
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 $54,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,192
Insurance broker organization code?3
Amount paid for insurance broker fees2049
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-005811-000
Policy instance 2
Insurance contract or identification number16-005811-000
Number of Individuals Covered982
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $59,925
Total amount of fees paid to insurance companyUSD $37,699
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $374,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,925
Amount paid for insurance broker fees37699
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-015142-00
Policy instance 1
Insurance contract or identification number01-015142-00
Number of Individuals Covered966
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $8,891
Total amount of fees paid to insurance companyUSD $1,946
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 $59,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,891
Insurance broker organization code?3
Amount paid for insurance broker fees1946
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-005811-000
Policy instance 2
Insurance contract or identification number16-005811-000
Number of Individuals Covered1039
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $64,860
Total amount of fees paid to insurance companyUSD $33,570
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $405,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,860
Amount paid for insurance broker fees33570
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-015142-00
Policy instance 1
Insurance contract or identification number01-015142-00
Number of Individuals Covered1303
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $12,441
Total amount of fees paid to insurance companyUSD $3,551
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 $77,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-005811-000
Policy instance 2
Insurance contract or identification number16-005811-000
Number of Individuals Covered1272
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $89,381
Total amount of fees paid to insurance companyUSD $37,022
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $558,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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