CHRISTIAN RETIREMENT HOMES INC has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: RIDGECREST VILLAGE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 76 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 65 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 65 |
| 2021: RIDGECREST VILLAGE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 93 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 76 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
| Total of all active and inactive participants | 2021-04-01 | 76 |
| 2020: RIDGECREST VILLAGE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 93 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
| Total of all active and inactive participants | 2020-04-01 | 93 |
| Total participants, beginning-of-year | 2020-01-01 | 151 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 133 |
| 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 | 133 |
| 2019: RIDGECREST VILLAGE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 104 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 104 |
| Total participants, beginning-of-year | 2019-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 151 |
| 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 | 151 |
| 2018: RIDGECREST VILLAGE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 109 |
| Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
| Total of all active and inactive participants | 2018-04-01 | 109 |
| Total participants, beginning-of-year | 2018-01-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 145 |
| 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 | 145 |
| 2017: RIDGECREST VILLAGE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 112 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
| Total of all active and inactive participants | 2017-04-01 | 112 |
| Total participants, beginning-of-year | 2017-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 160 |
| 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 | 160 |
| 2016: RIDGECREST VILLAGE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 152 |
| 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 | 152 |
| 2015: RIDGECREST VILLAGE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 156 |
| 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 | 156 |
| 2014: RIDGECREST VILLAGE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 154 |
| 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 | 154 |
| 2013: RIDGECREST VILLAGE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 139 |
| Total of all active and inactive participants | 2013-01-01 | 139 |
| 2011: RIDGECREST VILLAGE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 145 |
| Total of all active and inactive participants | 2011-04-01 | 145 |
| Total participants | 2011-04-01 | 145 |
| 2009: RIDGECREST VILLAGE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 133 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| 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 | 133 |
| Total participants | 2009-01-01 | 133 |
| 2022: RIDGECREST VILLAGE 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: RIDGECREST VILLAGE 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: RIDGECREST VILLAGE 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| 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: RIDGECREST VILLAGE 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: RIDGECREST VILLAGE 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 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: RIDGECREST VILLAGE 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | First time form 5500 has been submitted | Yes |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 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: RIDGECREST VILLAGE 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: RIDGECREST VILLAGE 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: RIDGECREST VILLAGE 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: RIDGECREST VILLAGE 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: RIDGECREST VILLAGE 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Submission has been amended | No |
| 2011-04-01 | This submission is the final filing | No |
| 2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-04-01 | Plan is a collectively bargained plan | No |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: RIDGECREST VILLAGE 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single 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 – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 095 |
| Policy instance | 2 |
| Insurance contract or identification number | 095 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $14,910 | | Health 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 $14,910 | | Additional information about fees paid to insurance broker | INDIRECT COMMISSIONS ALLOCATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33418 |
| Policy instance | 1 |
| Insurance contract or identification number | 33418 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 095 |
| Policy instance | 2 |
| Insurance contract or identification number | 095 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $17,220 | | Health 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 $17,220 | | Additional information about fees paid to insurance broker | INDIRECT COMMISSIONS ALLOCATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33418 |
| Policy instance | 1 |
| Insurance contract or identification number | 33418 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 095 |
| Policy instance | 2 |
| Insurance contract or identification number | 095 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $19,872 | | Health 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 $19,872 | | Additional information about fees paid to insurance broker | INDIRECT COMMISSIONS ALLOCATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33418 |
| Policy instance | 1 |
| Insurance contract or identification number | 33418 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $1,143 | | Total amount of fees paid to insurance company | USD $127 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,312 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $736 | | Additional information about fees paid to insurance broker | SALES COMMISSION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 127 |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 095 |
| Policy instance | 2 |
| Insurance contract or identification number | 095 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $21,636 | | Health 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 $21,636 | | Additional information about fees paid to insurance broker | INDIRECT COMMISSIONS ALLOCATION | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33418 |
| Policy instance | 1 |
| Insurance contract or identification number | 33418 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $1,203 | | Total amount of fees paid to insurance company | USD $252 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $7,201 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,203 | | Additional information about fees paid to insurance broker | SALES COMMISION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 252 |
|
| DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 ) |
| Policy contract number | M250000020 |
| Policy instance | 2 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $1,214 | | Total amount of fees paid to insurance company | USD $135 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,214 | | Additional information about fees paid to insurance broker | SALES COMMISION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 135 |
|
| WELLMARK HEALTH PLAN OF IOWA (National Association of Insurance Commissioners NAIC id number: 95531 ) |
| Policy contract number | 095 |
| Policy instance | 2 |
| Insurance contract or identification number | 095 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $22,572 | | Health 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 $22,572 | | Additional information about fees paid to insurance broker | INDIRECT COMMISSIONS ALLOCATION | | Insurance broker organization code? | 3 | | Insurance broker name | MOLYNEAUX INSURANCE |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 33418 |
| Policy instance | 1 |
| Insurance contract or identification number | 33418 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 ) |
| Policy contract number | M250000020 |
| Policy instance | 2 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $1,245 | | Total amount of fees paid to insurance company | USD $138 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,245 | | Additional information about fees paid to insurance broker | SALES COMMISION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 138 | | Insurance broker name | WELLMARK INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $1,291 | | Total amount of fees paid to insurance company | USD $143 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 143 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $1,291 | | Insurance broker name | LAMAIR MULOCK CONDON COMPANY |
|
| DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 ) |
| Policy contract number | M250000020 |
| Policy instance | 2 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 ) |
| Policy contract number | M250000020 |
| Policy instance | 2 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $1,313 | | Total amount of fees paid to insurance company | USD $146 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 146 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $1,313 | | Insurance broker name | LAMAIR MULOCK CONDON COMPANY |
|
| DEARBORN NATIONAL (National Association of Insurance Commissioners NAIC id number: 85090 ) |
| Policy contract number | M250000020 |
| Policy instance | 2 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | M250000020 |
| Policy instance | 1 |
| Insurance contract or identification number | M250000020 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $1,269 | | Total amount of fees paid to insurance company | USD $92 | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $452 | | Amount paid for insurance broker fees | 92 | | Insurance broker organization code? | 3 | | Insurance broker name | LAMAIR MULOCK CONDON COMPANY |
|
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) |
| Policy contract number | 90027 |
| Policy instance | 1 |
| Insurance contract or identification number | 90027 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | 20 |
| Policy instance | 2 |
| Insurance contract or identification number | 20 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $1,387 | | Total amount of fees paid to insurance company | USD $1,387 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
