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SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 401k Plan overview

Plan NameSUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN
Plan identification number 501

SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SUPERIOR DIE SET CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:SUPERIOR DIE SET CORPORATION
Employer identification number (EIN):390646900
NAIC Classification:332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01LYNETTE ELLMAN LYNETTE ELLMAN2018-08-09
5012016-01-01 LYNETTE ELLMAN2017-09-18
5012015-11-01LYNETTE ELLMAN LYNETTE ELLMAN2016-07-27
5012014-11-01LYNETTE ELLMAN LYNETTE ELLMAN2016-07-27
5012013-11-01LYNETTE ELLMAN LYNETTE ELLMAN2015-11-20
5012012-11-01LYNETTE ELLMAN LYNETTE ELLMAN2014-05-23
5012011-11-01LYNETTE ELLMAN LYNETTE ELLMAN2013-05-28
5012010-11-01LYNETTE ELLMAN LYNETTE ELLMAN2012-08-08
5012009-11-01LYNETTE ELLMAN LYNETTE ELLMAN2011-05-17

Plan Statistics for SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN

401k plan membership statisitcs for SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN

Measure Date Value
2022: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01120
Total number of active participants reported on line 7a of the Form 55002022-01-01111
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01112
2021: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01127
Total number of active participants reported on line 7a of the Form 55002021-01-01122
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-011
Total of all active and inactive participants2021-01-01123
2020: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01144
Total number of active participants reported on line 7a of the Form 55002020-01-01127
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-014
Total of all active and inactive participants2020-01-01131
2019: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01160
Total number of active participants reported on line 7a of the Form 55002019-01-01143
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0128
Total of all active and inactive participants2019-01-01172
2018: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01168
Total number of active participants reported on line 7a of the Form 55002018-01-01159
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01160
2017: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01168
Total number of active participants reported on line 7a of the Form 55002017-01-01166
Total of all active and inactive participants2017-01-01166
Total participants2017-01-01166
2016: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01175
Total number of active participants reported on line 7a of the Form 55002016-01-01168
Total of all active and inactive participants2016-01-01168
Total participants2016-01-01168
2015: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01176
Total number of active participants reported on line 7a of the Form 55002015-11-01175
Total of all active and inactive participants2015-11-01175
2014: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01185
Total number of active participants reported on line 7a of the Form 55002014-11-01176
Total of all active and inactive participants2014-11-01176
2013: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01193
Total number of active participants reported on line 7a of the Form 55002013-11-01185
Total of all active and inactive participants2013-11-01185
2012: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01186
Total number of active participants reported on line 7a of the Form 55002012-11-01193
Total of all active and inactive participants2012-11-01193
2011: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01184
Total number of active participants reported on line 7a of the Form 55002011-11-01186
Total of all active and inactive participants2011-11-01186
2010: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01172
Total number of active participants reported on line 7a of the Form 55002010-11-01184
Total of all active and inactive participants2010-11-01184
2009: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01172
Total number of active participants reported on line 7a of the Form 55002009-11-01172
Total of all active and inactive participants2009-11-01172

Form 5500 Responses for SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN

2022: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH 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 funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
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 funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes
2011: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – General assets of the sponsorYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – General assets of the sponsorYes
2010: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – General assets of the sponsorYes
2010-11-01Plan benefit arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – General assets of the sponsorYes
2009: SUPERIOR DIE SET CORPORATION EMPLOYEES HEALTH PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01This submission is the final filingNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – General assets of the sponsorYes
2009-11-01Plan benefit arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00540196
Policy instance 1
Insurance contract or identification number00540196
Number of Individuals Covered130
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $36,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00540196
Policy instance 1
Insurance contract or identification number00540196
Number of Individuals Covered131
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $35,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00540196
Policy instance 1
Insurance contract or identification number00540196
Number of Individuals Covered151
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $598
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $33,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees598
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00540196
Policy instance 1
Insurance contract or identification number00540196
Number of Individuals Covered153
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $31,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered166
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $918
Total amount of fees paid to insurance companyUSD $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 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
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered175
Insurance policy start date2015-11-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered176
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $5,094
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $355,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,094
Insurance broker organization code?3
Insurance broker nameWILLIS INS SERVICES OF GA INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered185
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $411,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered193
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $388,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered186
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $349,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number623313
Policy instance 1
Insurance contract or identification number623313
Number of Individuals Covered184
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $412,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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