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LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 401k Plan overview

Plan NameLIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN
Plan identification number 501

LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN Benefits

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

401k Sponsoring company profile

LIFE TIME, INC. has sponsored the creation of one or more 401k plans.

Company Name:LIFE TIME, INC.
Employer identification number (EIN):411689746
NAIC Classification:713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01
5012020-10-01
5012019-10-01
5012018-10-01
5012017-10-01
5012016-10-01STEVE KERZMAN
5012015-10-01STEVE KERZMAN
5012014-10-01STEVE KERZMAN
5012013-10-01STEVE KERZMAN
5012012-10-01STEVE KERZMAN
5012011-10-01STEVE KERZMAN
5012010-10-01STEVE KERZMAN
5012009-10-01STEVE KERZMAN
5012008-10-01STEVE KERZMAN STEVE KERZMAN2010-04-29
5012007-10-01STEVE KERZMAN STEVE KERZMAN2010-04-29
5012006-10-01STEVE KERZMAN STEVE KERZMAN2010-04-29

Plan Statistics for LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN

401k plan membership statisitcs for LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN

Measure Date Value
2021: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-014,947
Total number of active participants reported on line 7a of the Form 55002021-10-015,134
Number of retired or separated participants receiving benefits2021-10-01148
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-015,282
2020: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-015,613
Total number of active participants reported on line 7a of the Form 55002020-10-014,666
Number of retired or separated participants receiving benefits2020-10-01154
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-014,820
2019: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-016,674
Total number of active participants reported on line 7a of the Form 55002019-10-015,915
Number of retired or separated participants receiving benefits2019-10-01211
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-016,126
2018: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-016,191
Total number of active participants reported on line 7a of the Form 55002018-10-016,281
Number of retired or separated participants receiving benefits2018-10-0133
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-016,314
2017: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-017,925
Total number of active participants reported on line 7a of the Form 55002017-10-018,306
Number of retired or separated participants receiving benefits2017-10-0182
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-018,388
2016: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-017,272
Total number of active participants reported on line 7a of the Form 55002016-10-017,428
Number of retired or separated participants receiving benefits2016-10-0167
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-017,495
2015: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-017,117
Total number of active participants reported on line 7a of the Form 55002015-10-016,927
Number of retired or separated participants receiving benefits2015-10-01147
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-017,074
2014: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-016,229
Total number of active participants reported on line 7a of the Form 55002014-10-016,991
Number of retired or separated participants receiving benefits2014-10-0143
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-017,034
2013: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-016,115
Total number of active participants reported on line 7a of the Form 55002013-10-016,211
Number of retired or separated participants receiving benefits2013-10-0118
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-016,229
2012: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-016,257
Total number of active participants reported on line 7a of the Form 55002012-10-015,780
Number of retired or separated participants receiving benefits2012-10-019
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-015,789
2011: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-015,926
Total number of active participants reported on line 7a of the Form 55002011-10-015,871
Number of retired or separated participants receiving benefits2011-10-0170
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-015,941
2010: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-015,821
Total number of active participants reported on line 7a of the Form 55002010-10-015,955
Number of retired or separated participants receiving benefits2010-10-0175
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-016,030
2009: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-015,781
Total number of active participants reported on line 7a of the Form 55002009-10-015,729
Number of retired or separated participants receiving benefits2009-10-0184
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-015,813
2008: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year2008-10-015,781
Total number of active participants reported on line 7a of the Form 55002008-10-015,729
Number of retired or separated participants receiving benefits2008-10-010
Number of other retired or separated participants entitled to future benefits2008-10-010
Total of all active and inactive participants2008-10-015,729
2007: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2007 401k membership
Total participants, beginning-of-year2007-10-014,399
Total number of active participants reported on line 7a of the Form 55002007-10-015,781
Number of retired or separated participants receiving benefits2007-10-010
Number of other retired or separated participants entitled to future benefits2007-10-010
Total of all active and inactive participants2007-10-015,781
2006: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2006 401k membership
Total participants, beginning-of-year2006-10-012,464
Total number of active participants reported on line 7a of the Form 55002006-10-014,399
Number of retired or separated participants receiving benefits2006-10-010
Number of other retired or separated participants entitled to future benefits2006-10-010
Total of all active and inactive participants2006-10-014,399

Form 5500 Responses for LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN

2021: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Submission has been amendedNo
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planNo
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planNo
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planNo
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2010: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan funding arrangement – General assets of the sponsorYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes
2008: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo
2008-10-01Plan funding arrangement – InsuranceYes
2008-10-01Plan funding arrangement – General assets of the sponsorYes
2008-10-01Plan benefit arrangement – InsuranceYes
2008-10-01Plan benefit arrangement – General assets of the sponsorYes
2007: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2007 form 5500 responses
2007-10-01Type of plan entitySingle employer plan
2007-10-01Submission has been amendedNo
2007-10-01This submission is the final filingNo
2007-10-01This return/report is a short plan year return/report (less than 12 months)No
2007-10-01Plan is a collectively bargained planNo
2007-10-01Plan funding arrangement – InsuranceYes
2007-10-01Plan funding arrangement – General assets of the sponsorYes
2007-10-01Plan benefit arrangement – InsuranceYes
2007-10-01Plan benefit arrangement – General assets of the sponsorYes
2006: LIFE TIME FITNESS, INC. MEDICAL, GROUP LIFE, AD&D, DENTAL & DISABILITY PLAN 2006 form 5500 responses
2006-10-01Type of plan entitySingle employer plan
2006-10-01Submission has been amendedNo
2006-10-01This submission is the final filingNo
2006-10-01This return/report is a short plan year return/report (less than 12 months)No
2006-10-01Plan is a collectively bargained planNo
2006-10-01Plan funding arrangement – InsuranceYes
2006-10-01Plan funding arrangement – General assets of the sponsorYes
2006-10-01Plan benefit arrangement – InsuranceYes
2006-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649292
Policy instance 1
Insurance contract or identification number649292
Number of Individuals Covered7737
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649292
Policy instance 2
Insurance contract or identification number649292
Number of Individuals Covered1932
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $10,990
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number649292
Policy instance 3
Insurance contract or identification number649292
Number of Individuals Covered2841
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number9914615
Policy instance 4
Insurance contract or identification number9914615
Number of Individuals Covered124
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,726
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 number9914607
Policy instance 5
Insurance contract or identification number9914607
Number of Individuals Covered2538
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $145,891
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 number9914599
Policy instance 6
Insurance contract or identification number9914599
Number of Individuals Covered4401
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $298,430
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 number9914623
Policy instance 7
Insurance contract or identification number9914623
Number of Individuals Covered59
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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