WISCONSIN PUBLIC SERVICE CORPORATION (WPSC) has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN
401k plan membership statisitcs for WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2020: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 42 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 0 |
| 2019: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 42 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 42 |
| 2018: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 48 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 4 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 43 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 47 |
| 2017: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 4 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 44 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 48 |
| 2016: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 4 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 42 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 46 |
| 2015: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 56 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 4 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 43 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 47 |
| 2014: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 87 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 44 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 79 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 123 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| 2013: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 89 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 30 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 57 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 87 |
| 2012: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 93 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 31 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 58 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 89 |
| 2011: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 34 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 59 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 93 |
| 2009: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 72 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 35 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 42 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 77 |
| Measure | Date | Value |
|---|
| 2017 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $25 |
| Total plan liabilities at beginning of year | 2017-12-31 | $82 |
| Total income from all sources | 2017-12-31 | $239,815 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $221,912 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $191,165 |
| Total plan assets at end of year | 2017-12-31 | $36,024 |
| Total plan assets at beginning of year | 2017-12-31 | $18,178 |
| Value of fidelity bond covering the plan | 2017-12-31 | $25,000,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $160,749 |
| Net income (gross income less expenses) | 2017-12-31 | $17,903 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $35,999 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $18,096 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $79,066 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $30,747 |
| 2016 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $82 |
| Total plan liabilities at beginning of year | 2016-12-31 | $76 |
| Total income from all sources | 2016-12-31 | $281,318 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $281,423 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $273,409 |
| Total plan assets at end of year | 2016-12-31 | $18,178 |
| Total plan assets at beginning of year | 2016-12-31 | $18,277 |
| Value of fidelity bond covering the plan | 2016-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $189,662 |
| Net income (gross income less expenses) | 2016-12-31 | $-105 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $18,096 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $18,201 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $91,656 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $8,014 |
| 2015 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $76 |
| Total plan liabilities at beginning of year | 2015-12-31 | $1,247 |
| Total income from all sources | 2015-12-31 | $178,365 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $177,546 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $171,597 |
| Total plan assets at end of year | 2015-12-31 | $18,277 |
| Total plan assets at beginning of year | 2015-12-31 | $18,629 |
| Value of fidelity bond covering the plan | 2015-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $99,635 |
| Net income (gross income less expenses) | 2015-12-31 | $819 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $18,201 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $17,382 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $78,730 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $5,949 |
| 2014 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $1,247 |
| Total plan liabilities at beginning of year | 2014-12-31 | $1,624 |
| Total income from all sources | 2014-12-31 | $337,301 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $331,158 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $310,890 |
| Total plan assets at end of year | 2014-12-31 | $18,629 |
| Total plan assets at beginning of year | 2014-12-31 | $12,863 |
| Value of fidelity bond covering the plan | 2014-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $145,874 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $20,268 |
| Net income (gross income less expenses) | 2014-12-31 | $6,143 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $17,382 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $11,239 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $191,427 |
| 2013 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $1,624 |
| Total plan liabilities at beginning of year | 2013-12-31 | $1,502 |
| Total income from all sources | 2013-12-31 | $281,947 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $282,236 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $260,474 |
| Total plan assets at end of year | 2013-12-31 | $12,863 |
| Total plan assets at beginning of year | 2013-12-31 | $13,030 |
| Value of fidelity bond covering the plan | 2013-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $174,753 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $21,762 |
| Net income (gross income less expenses) | 2013-12-31 | $-289 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $11,239 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $11,528 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $107,194 |
| 2012 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $333,557 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $335,904 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $312,526 |
| Total plan assets at end of year | 2012-12-31 | $11,529 |
| Total plan assets at beginning of year | 2012-12-31 | $13,876 |
| Value of fidelity bond covering the plan | 2012-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $191,032 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $23,378 |
| Net income (gross income less expenses) | 2012-12-31 | $-2,347 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $11,529 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $13,876 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $142,525 |
| 2011 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $383,388 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $391,576 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $369,549 |
| Total plan assets at end of year | 2011-12-31 | $13,876 |
| Total plan assets at beginning of year | 2011-12-31 | $22,064 |
| Value of fidelity bond covering the plan | 2011-12-31 | $15,000,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $189,623 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $22,027 |
| Net income (gross income less expenses) | 2011-12-31 | $-8,188 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $13,876 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $22,064 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $193,765 |
| 2010 : WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $362,117 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $373,050 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $350,640 |
| Total plan assets at end of year | 2010-12-31 | $22,064 |
| Total plan assets at beginning of year | 2010-12-31 | $32,997 |
| Value of fidelity bond covering the plan | 2010-12-31 | $10,000,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $207,208 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $22,410 |
| Net income (gross income less expenses) | 2010-12-31 | $-10,933 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $22,064 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $32,997 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $154,909 |
| 2020: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | Yes |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Multi-employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Multi-employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Multi-employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: WISCONSIN PUBLIC SERVICE CORPORATION KEY EMPLOYEE POST-RETIREMENT HEALTH CARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Multi-employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9713207 |
| Policy instance | 1 |
| Insurance contract or identification number | 9713207 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $55 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9798729 |
| Policy instance | 2 |
| Insurance contract or identification number | 9798729 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $29 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15 | | Insurance broker organization code? | 3 |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | 24271 |
| Policy instance | 3 |
| Insurance contract or identification number | 24271 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $43,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9713207 |
| Policy instance | 1 |
| Insurance contract or identification number | 9713207 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $123 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $123 | | Insurance broker organization code? | 3 |
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9798729 |
| Policy instance | 2 |
| Insurance contract or identification number | 9798729 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $63 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63 | | Insurance broker organization code? | 3 |
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| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | 24271 |
| Policy instance | 3 |
| Insurance contract or identification number | 24271 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $95,572 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9713207 |
| Policy instance | 1 |
| Insurance contract or identification number | 9713207 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $123 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $123 | | Insurance broker organization code? | 3 | | Insurance broker name | VERITAS RISK SERVICES - BOR |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9798729 |
| Policy instance | 2 |
| Insurance contract or identification number | 9798729 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $69 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69 | | Insurance broker organization code? | 3 | | Insurance broker name | VERITAS RISK SERVICES - BOR |
|
| SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 ) |
| Policy contract number | 24271 |
| Policy instance | 3 |
| Insurance contract or identification number | 24271 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $112,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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