FAIRVIEW HEALTH SERVICES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT
401k plan membership statisitcs for FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT
| Measure | Date | Value |
|---|
| 2022: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 33,402 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 34,615 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 34,615 |
| 2021: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 26,572 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 30,030 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 30,030 |
| 2020: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 28,985 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 26,572 |
| 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 | 26,572 |
| 2019: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 23,392 |
| 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 | 0 |
| 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 | 0 |
| 2018: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 23,733 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 23,392 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| 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 | 23,392 |
| 2017: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| 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 | 0 |
| 2016: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 22,374 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 23,020 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| 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 | 23,020 |
| 2015: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 21,593 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 22,374 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| 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 | 22,374 |
| 2014: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 21,610 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 21,593 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| 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 | 21,593 |
| 2013: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 22,494 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 21,610 |
| Total of all active and inactive participants | 2013-01-01 | 21,610 |
| 2012: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 21,877 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 22,494 |
| Total of all active and inactive participants | 2012-01-01 | 22,494 |
| 2011: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 20,680 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 21,877 |
| Total of all active and inactive participants | 2011-01-01 | 21,877 |
| 2009: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 21,411 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 20,810 |
| Total of all active and inactive participants | 2009-01-01 | 20,810 |
| Measure | Date | Value |
|---|
| 2012 : FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Was this plan covered by a fidelity bond | 2012-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| 2011 : FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Was this plan covered by a fidelity bond | 2011-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| 2010 : FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2010 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| 2022: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: FAIRVIEW HEALTH SERVICES ACCIDENTAL DEATH & DISMEMBERMENT 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP 0009155637 |
| Policy instance | 1 |
| Insurance contract or identification number | GTP 0009155637 | | Number of Individuals Covered | 34615 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,624 | | 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 | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL 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 Carrier | USD $24,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,624 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155637 |
| Policy instance | 1 |
| Insurance contract or identification number | GTP0009155637 | | Number of Individuals Covered | 26515 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-10-01 | | Total amount of commissions paid to insurance broker | USD $3,624 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $24,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,624 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155637 |
| Policy instance | 1 |
| Insurance contract or identification number | GTP0009155637 | | Number of Individuals Covered | 26572 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-10-01 | | Total amount of commissions paid to insurance broker | USD $1,275 | | Other welfare benefits provided | ACCDTL DEATH & DISMEMBER & PARALYSI | | Welfare Benefit Premiums Paid to Carrier | USD $8,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,275 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009155637 |
| Policy instance | 1 |
| Insurance contract or identification number | GTP0009155637 | | Number of Individuals Covered | 28985 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $1,275 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,275 |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | GTP0009155637 |
| Policy instance | 1 |
| Insurance contract or identification number | GTP0009155637 | | Number of Individuals Covered | 22623 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-10-01 | | Total amount of commissions paid to insurance broker | USD $1,275 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,275 |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | GTP0009126228-C |
| Policy instance | 1 |
| Insurance contract or identification number | GTP0009126228-C | | Number of Individuals Covered | 23020 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2018-10-01 | | Total amount of commissions paid to insurance broker | USD $1,668 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,668 |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | SRG 0009115875 |
| Policy instance | 1 |
| Insurance contract or identification number | SRG 0009115875 | | Number of Individuals Covered | 23020 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $4,148 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,148 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | SRG 0009115875 |
| Policy instance | 1 |
| Insurance contract or identification number | SRG 0009115875 | | Number of Individuals Covered | 22374 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,148 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,148 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | SRG 0009115875 |
| Policy instance | 1 |
| Insurance contract or identification number | SRG 0009115875 | | Number of Individuals Covered | 21593 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $150 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $150 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | SRG 0009115875 |
| Policy instance | 1 |
| Insurance contract or identification number | SRG 0009115875 | | Number of Individuals Covered | 21612 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-02-01 | | Total amount of commissions paid to insurance broker | USD $116 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $116 | | Insurance broker name | MARSH & MCLENNAN AGENCY LLC |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | GTP-009126628-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP-009126628-A | | Number of Individuals Covered | 22494 | | Insurance policy end date | 2013-02-01 | | Total amount of commissions paid to insurance broker | USD $4,067 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,067 | | Insurance broker name | RJF AGENCIES INC |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | GTP-8043447-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP-8043447-A | | Insurance policy end date | 2012-02-01 | | Total amount of commissions paid to insurance broker | USD $4,068 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | GTP-8043447-A |
| Policy instance | 1 |
| Insurance contract or identification number | GTP-8043447-A | | Insurance policy end date | 2011-02-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
